A rare cause of acute abdomen: Isolated necrosis of the cecum.

We would like to present the case of a 76-year-old female patient with cecal necrosis, which is a rare cause of acute abdomen in elderly women and a variant of ischemic colitis. The patient was admitted to our hospital with abdominal pain, anorexia, and nausea. Physical examination, laboratory parameters, and abdominal computed tomography revealed acute abdomen. We operated the patient with an infra-umbilical midline incision. Considering the pain localized to the right lower quadrant, our initial diagnosis was acute appendicitis; however, we kept in mind other differential diagnoses as well. After laparotomy Non-occlusive cecal necrosis was detected. Arterial pulse was palpated; however, no signs of trombus were detected. Patient also have a Meckel's diverticulum. Terminal ileum plus cecum resection and Meckel's diverticulum excision were performed. Isolated necrosis of the cecum may be caused due to multiple reasons. Especially in elderly female patients with predisposing factors like hypotension, sepsis, shock, drug use, vasculitis, and hypercoagulability, cecal necrosis should be kept in mind.

Separate and synergistic effects of taurolidine and icodextrin in intra-abdominal adhesion prevention.

BACKGROUND: In our present study, we aimed to evaluate the effects of taurolidine, a blocking agent of fibrin deposition, and icodextrin, a colloid osmotic material that also inhibits fibrin accumulation, and the effect of their application separately and concomittantly in intra-abdominal adhesion prevention. METHODS: Forty BALB/c male mice, weighing 30-35 g and 11-12 weeks old were divided into four groups as follows: group 1: control group, group 2: taurolidine group, group 3: icodextrin group, and group 4: taurolidine and icodextrin group. Animals were sacrificed by cervical dislocation after 14 days. The adhesions were classified and scored by two blinded researchers according to Nair's macroscopic adhesion staging system and microscopically evaluated using Zuhlke classification system. RESULTS: In group 2 there was no mice with score 4. In group 3, scores 3 and 4 were absent. Scores 2, 3, and 4 were not detected in group 4. The mean value of adhesion scores decreased from groups 1 to 4. There was a significant statistical difference between all the groups and group 1. There was no change between the study groups on macroscopic examination, whereas histopathological examination revealed statistically significance between group 4 and other groups. CONCLUSION: Taurolidine and icodextrin, when used alone or together, decrease postoperative intra-abdominal adhesion formation. Macroscopic appearence was not supportive of statistical difference between group 4 and other groups. Microscopic evaluation paves the road for future studies for determining significance when taurolidine and icodextrin are applied concomittantly. Additional experimental studies are required for dose adjustment.

Current approach to liver traumas.

INTRODUCTION: Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. PRESENTATION OF CASE: Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013. Patient demographics, hepatic panel, APTT (activated partial thromboplastin time), PT (prothrombin time), INR (international normalized ratio), fibrinogen, biochemistry panel were recorded. Hemodynamic instability was the most prominent factor for surgery decision, in the lead of current Advanced Trauma Life Support (ATLS) protocols. Operation records and imaging modalities revealed liver injuries according to the Organ Injury Scale of the American Association for the Surgery of Trauma. 300 patients admitted to emergency department were included in our study (187 males and 113 females). Mean age was 47 years (range, 12-87). The overall mortality rate was 13% (40 out of 300). Major factor responsible for mortality rates and outcome was stability of cases on admission. 188 (% 63) patients were counted as stable, whereas 112 (% 37) cases were found unstable (blood pressure ≤ 90, after massive resuscitation). 192 patients were observed conservatively, whereas 108 cases received abdominal surgery. High levels of AST, ALT, LDH, INR, creatinine and low levels of fibrinogen and low platelet counts on admission were found to be associated with mortality and these cases also had Grade 4 and 5 injuries. Hemodynamic instability on admission and the type and grade of injury played major role in mortality rates). Packing was performed in 35 patients, with Grade 4 and 5 injuries. Mortality rate was %13 (40 out of 300). CONCLUSION: A multidisciplinary approach to the management of hepatic injuries has evolved over the last few decades, but the basic principles of trauma continue to be observed. Diagnostic and therapeutic endeavors are chosen based mainly on the stability of the patient. Stable patients with reliable examinations and available resources can be managed nonoperatively. Unstable patients require surgery. Our current approach to liver traumas is non operative technique, if possible.

A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer.

BACKGROUND: Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. METHODS: Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately. RESULTS: At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1 ± 1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9 ± 1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection. CONCLUSION: The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.

Is there any role of thrombin activatable fibrinolysis inhibitor in the development of a hypercoagulable state in gastric cancer.

BACKGROUND: The purpose of this study was to investigate plasma levels of thrombin activatable fibrinolysis inhibitor (TAFI) and TAFI's relationship with coagulation markers (prothrombin fragment 1 + 2) in gastric cancer patients. METHODS: Thirty-three patients with gastric adenocarcinoma and 29 healthy control subjects were prospectively enrolled in the study. Patients who had a history of secondary malignancy, thrombosis related disease, oral contraceptive use, diabetes mellitus, chronic renal failure or similar chronic metabolic disease were excluded from the study. A fasting blood sample was drawn from patients to determine the plasma levels of TAFI and Prothrombin Fragment 1 + 2 (F 1 + 2). In addition, data on patient age, sex, body mass index (BMI) and stage of disease were recorded. The same parameters, except stage of disease, were also recorded for the control group. Subsequently, we assessed the difference in the levels of TAFI and F 1 + 2 between the patient and control groups. Moreover, we investigated the relation of TAFI and F 1 + 2 levels with age, sex, BMI and stage of disease in the gastric cancer group. RESULTS: There were no statistical differences in any demographic variables (age, gender and BMI) between the groups (Table 1). The mean plasma TAFI levels of the gastric cancer group (69.4 ± 33.1) and control group (73.3 ± 27.5) were statistically similar (P = 0.62). The mean plasma F 1 + 2 level in the gastric cancer group was significantly higher than for those in the control group (549.7 ± 325.3 vs 151.9 ± 67.1, respectively; P < 0.001). In the gastric cancer group, none of the demographic variables (age, gender and BMI) were correlated with either TAFI or F 1 + 2 levels. Also, no significant associations were found between the stage of the cancer and either TAFI or F 1 + 2 levels. CONCLUSION: In our study, TAFI levels of gastric cancer patients were similar to healthy subjects. The results of our study suggest that TAFI does not play a role in pathogenesis of the hypercoagulable state in gastric cancer patients.

Intra-abdominal use of phosphodiesterase type 4 inhibitor in postoperative adhesion prevention: an experimental study on mice.

OBJECTIVE: The study was designed to assess the value of intraperitoneal use of rolipram for adhesion prevention and to compare the results with placebo and a sodium hyaluronate/carboxymethylcellulose absorbable barrier (Seprafilm), in a murine cecal abrasion model. DESIGNS: Twenty-four Balb/c mice were subjects of this study. Intra-abdominal adhesions were created with a multiple-abrasion model consisting of meticulous abrasion of the cecum and small-bowel segments with strokes of a dental toothbrush. Animals in groups R (n = 8) received 1 mL of rolipram intraperitoneally. Seprafilm was placed over the viscera under the incision in group S animals (n = 8). Group C animals (n = 8) were reserved as control and received nothing. Animals were killed on day 22. MAIN OUTCOME MEASURES: The adhesions were evaluated with 2 different observational scoring systems, the Majuzi System and the Linsky Scale. After completion of observational evaluation, the cecum and small bowel of the animals were excised and sent to the pathology laboratory for histopathologic examination. The extent of inflammatory response, the extent of the fibrotic reaction, the extent of the necrosis and abscess formation, and the extent of foreign body reaction were histologically evaluated. RESULTS: The mean Majuzi System scores of groups R and S were similar to each other and significantly less than control group. Also, all scores of the Linsky Scale in group R were similar to those in group S, and significantly less than those in the control group. Histologically, the mean score of inflammatory response in group R was less than both those in group C and group S. The mean score of fibrotic reaction in group R was significantly less than those in the control group. CONCLUSION: These results indicate that rolipram may be an effective material in prevention of postoperative intra-abdominal adhesions, but it is obvious that further studies are needed to validate the results of this limited initial study.

Acute mechanical intestinal obstructions.

BACKGROUND: In this study, we evaluated our treatment modality and timing of surgery in acute mechanical intestinal obstruction (AMIO) patients who were admitted to the emergency room. METHODS: Only patients with the diagnosis of AMIO were included in this study. Surgery was performed in patients with hemodynamic instability despite fluid resuscitation and peritoneal signs upon physical examination. Patients were divided into two groups. Adhesion cases were assigned to Group 1, while non-adhesion cases were assigned to Group 2. The decision to provide surgical or medical therapy was assessed 24 hours (h) after admission. RESULTS: Twenty-two patients in Group 1 and 53 patients in Group 2 underwent surgical procedures. The difference between the groups was statistically different (p < 0.05). The mean monitoring time after admission to the hospital was 128.3 +/- 24.85 h and 43.1 +/- 15.51 h in Groups 1 and 2, respectively (p = 0.0001). In Group 2, 76.6% of the patients who were monitored for over 24 hours required surgery. In contrast, this rate was only 36% in Group 1 (p < 0.05). CONCLUSION: Our clinical experience shows that medical therapy and monitoring over 24 hours is not a good substitute for surgical treatment of AMIO when the obstruction is not due to an adhesion.

Acute abdomen due to rupture of hemangiopericytoma of the greater omentum: case report.

Hemangiopericytoma (HP) is a vascular tumor that mostly develops in soft tissues. The greater omentum is a very rare site for its occurrence. We present herein the clinical evaluation and outcome of a very rare case of HP that caused acute abdomen. We evaluated a case of acute abdomen due to rupture of a HP of the greater omentum. The clinical and laboratory findings and treatment modality are reported. A 70-year-old patient with severe abdominal pain was operated with the diagnosis of acute abdomen. A semi-solid mass (12 x 10 x 6 cm) originating from the greater omentum was detected during surgery. There was active bleeding from the tumor. Pathologic evaluation of this lesion was reported as benign HP. HP of the greater omentum can be the cause of intraabdominal bleeding leading to acute abdomen. Surgical resection is the treatment of choice, especially in benign hemangiopericytomas.

The effect of taurolidine on experimental thrombus formation.

Venous thrombosis can be the source of emboli, a significant health risk encountered throughout surgical and medical clinics. Taurolidine is an antimicrobial agent used to prevent intraabdominal adhesion formation and sepsis in experimental and clinical trials. The aim of this study is to evaluate effect of taurolidine on experimental thrombus formation and make a comparison with low-molecular weight heparin. Four groups of ten Wistar-Albino rats (300-350 g) were used; with the first and second groups each being administered 10 and 20 mg of taurolidine, the third group low-molecular weight heparin and the fourth group saline solution (control group) respectively. Experimental thrombus formation was performed in rats in the area of the abdominal inferior vena cava by using a combination of stasis and hypercoagulability described by Wessler et al. [Wessler, S., Reimer, S.M., Sheps, M.C., 1959. Biologic assay of a thrombosis inducing activity in human serum. J. Appl. Physiol. 14:943-946.]. Thrombocyte count, the weight of thrombus, prothrombin time and activated partial thromboplastin time and activities of coagulation factors were measured and compared across groups. Thrombus weights in the taurolidine treated groups were lower than the control group and greater than the low-molecular weight heparin treated group. Taurolidine was found to decrease activities of coagulation factors V, VIII, IX, XI and XII. Taurolidine showed no effect on activated partial thromboplastin time and prothrombin time values; however, it decreased thrombus weight, but not as much as low-molecular weight heparin. The cause of these findings in our study may be related to the minimized effect of taurolidine on factor II, VII, and X activities. These effects likely render the agent ineffective in the prevention of venous thrombosis. Taurolidine was found to be less effective than low-molecular weight heparin in prevention of thrombus formation.

The role of simvastatin on postoperative peritoneal adhesion formation in an animal model.

AIM: The aim of this study is to show the effect of simvastatin on intra-abdominal adhesion formation. METHOD: Adhesion formation was achieved by scratching the cecum and anterior abdominal wall following median laparotomy. Three different groups of 10 rats each were formed. In group I, 0.57 mg/kg/day simvastatin was injected intraperitoneally right after the operation and for 5 days thereafter. In group II, an equal dose of simvastatin to that used in group I was given via gavage. A physiological saline solution was given to group III for the same period of time. On the 6th and 14th day, blood samples were taken and peritoneal lavage was performed to measure the tissue-type plasminogen activator (t-PA) activity. Adhesions were graded via re-laparotomies on the 14th day after the first operation. RESULTS: The adhesion scores were 1.40 +/- 0.22, 1.50 +/- 0.26, and 2.90 +/- 0.34 in groups I, II, and III, respectively (p = 0.007), and the score was higher in group III than in the other groups (p = 0.005, p = 0.011). CONCLUSION: Intraperitoneal simvastatin application decreases adhesion formation by increasing the t-PA level in abdominal surgery.

Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up.

PURPOSE: We have previously introduced a minimally invasive technique for the treatment of limited pilonidal disease. In this paper, the results for patients who had at least one year of follow-up are provided. METHODS: All patients operated with the sinus excision technique were studied retrospectively and those who had a follow-up period shorter than 12 months were excluded. Demographics, perioperative and postoperative data, and patient satisfaction scores were obtained from a prospectively designed database. Limited pilonidal disease was defined as disease presenting with less than four visible pits. RESULTS: Sixty-two patients (56 males, 90.3 percent; mean age, 25.8 +/- 10.4 years) were included in the study. Patients returned to work in 1.9 +/- 0.7 days, and the mean healing period was 43 +/- 10.4 days. All procedures were performed under local anesthesia, and the mean operation time was 9.7 +/- 3.4 minutes. The number of outpatient procedures was 45 (72.6 percent). One patient suffered from a minor complication (bleeding that was stopped with electrocauterization; n = 1, 1.6 percent) and recurrence was observed in another case (n = 1, 1.6 percent). Patients received a satisfaction questionnaire, which revealed that 34 patients (54.8 percent) were "completely satisfied with the procedure" and 49 (79 percent) would "absolutely recommend the technique to other patients." CONCLUSIONS: Sinus excision is an advisable technique for the treatment of limited pilonidal disease, because it can be performed under local anesthesia mostly as an outpatient procedure and the operation time is extremely short. Although the healing period is long, the off-work period is short, and patients are generally satisfied with the procedure. After a medium-term follow-up, the complication and recurrence rates are acceptable. We believe that sinus excision technique is a simple and effective method for the treatment of limited pilonidal disease.

Role of glyceryl trinitrate, a nitric oxide donor, in the renal ischemia-reperfusion injury of rats.

BACKGROUND/AIMS: Ischemia-reperfusion injury is a serious clinical situation which can cause serious morbidity and mortality. An experimental renal ischemia-reperfusion injury model was designed to evaluate the role of glyceryl trinitrate (GTN) on renal function and histology. METHODS: 50 Wistar albino rats were used in our study. Five groups were formed: (1) sham-control group; (2) acute renal ischemia (ARI) group with placebo (0.9% NaCl) infusion; (3) GTN infusion with a 75 microg/kg/min dose prior to ARI was administered; (4) GTN infusion with a 150 microg/kg/min dose prior to ARI was given, and finally (5) 150 microg/kg/min GTN infusion after the ARI period was applied. Serum BUN and creatinine levels were measured for evaluation of renal function. T(max-sec), glomerular filtration rate (GFR), and T(max-min) results following a (99m)Tc-DTPA diuretic renal scintigraphy were used. Histological examination was performed on nephrectomy specimens. RESULTS: Groups 2 and 5 showed higher BUN, creatinine, and lower GFR values than the other groups (p = 0.0001). There was no difference in BUN, creatinine, and GFR levels between groups 2 and 5 (p = 0.971, p = 0.739, p = 0.393). Also the T(max-sec) values were higher in groups 2 and 5 compared with the other groups (p = 0.0001). The presence of tubular necrosis was different between groups and was higher in groups 2 and 5 (p = 0.002). CONCLUSION: The application of GTN, a nitric oxide donor, has caused significant improvement in renal function when applied prior to an experimentally designed renal ischemia-reperfusion model. But administration of GTN had no effect after occurrence of ischemia.

Effect of a selective cyclooxygenase-2 inhibitor on renal scarring.

BACKGROUND: Scarring is one of the steps of excessive wound healing, causing dysfunction of the involved tissues and clinically poor cosmetics. The aim of this study was to examine the effect of a highly selective cyclooxygenase-2 (COX-2) inhibitor on renal scar formation in experimental pyelonephritis. MATERIALS AND METHODS: Four groups of 10 Balb/C mice were formed. In groups I and II following the inoculation of lipopolysaccharide (LPS) into both kidneys, 0.18 and 0.36 mg/day of rofecoxib was given respectively via intraperitoneal route for 5 days. No medication was applied following physiological saline solution injection to both kidneys of the mice in group III (negative control group). After group IV's LPS inoculation on the first day, saline solution (1 ml/day) was given intraperitoneally for 5 days (positive control group). Following the exposure of both kidneys, LPS of Escherichia coli (5 mg/kg) was injected into the kidneys of groups I, II, and IV. In group III, saline solution (0.1 ml) was used instead of LPS. Three days after the inoculation of LPS, solutions containing 0.18 and 0.36 mg of COX-2 inhibitor were given intraperitoneally for 5 days in groups I and II. No medication was used for the mice in group III. Six weeks after the inoculation of LPS and saline solution, all mice were humanely euthanized. Bilateral nephrectomies were done on each group of mice, and histopathological examination was performed. RESULTS: Inoculation of LPS into the renal parenchyma caused pyelonephritis and scar formation in all groups. The degree of pyelonephritis and scar formation was lesser in groups in which COX-2 inhibitors were used. The degree of scar formation was lesser in group II, in which 0.36 mg more of COX-2 inhibitor was used than in group I (0.18 mg of COX-2 inhibitor). CONCLUSION: In our study model, direct inoculation of LPS to kidneys caused experimentally induced pyelonephritis. Renal scar formation was effectively prevented through the utilization of rofecoxib at 0.36-mg doses.

Effect of proton pump inhibitors on hepatic regeneration.

INTRODUCTION: The liver is critical in multiple processes, including the clearance of endogenous compounds, the synthesis of macromolecules, and organ-specific biotransformation processes. Therefore, the liver's regenerating capacity is of vital importance. Multiple pathways are activated in the complex process that leads to hepatic regeneration. In the present study, we aimed to evaluate the effect of proton pump inhibitors omeprozole, lansoprazole, and pantoprazole on hepatic regeneration following partial hepatectomy. MATERIALS AND METHODS: Four groups were formed with 32 rats in each. Partial liver resections were performed for all animals. Omeprazole (71.4 microg/day), lansoprazole (107 microg/day), pantoprazole (143 microg/day) and placebo (0.5 cm(3)) were administered to the groups respectively. A quarter of the rats in each group were sacrificed on the 1st postoperative day. The rest were sacrificed on the 3rd, 5th and 7th postoperative days. The remnant regenerating liver mass was removed and weighed, and Ki-67 monoclonal antibody levels were measured. RESULTS: There was no statistical difference between the four groups on the first day in evaluating the weight of the liver mass (p = 0.09) and Ki-67 (p = 0.268) levels. Only the omeprazole group showed a difference; the Ki-67 level was lower in the omeprazole group on the 3rd (p = 0.003, p = 0.0001, p = 0.003), 5th (p = 0.017, p = 0.001, p = 0.0001) and 7th (p = 0.0001) days compared to the other groups. Also the weight of the remnant liver mass was lower in the omeprazole group on the 3rd, 5th and 7th (p = 0.0001) days. CONCLUSION: We figured out that lansoprazole and pantoprazole have no effects on liver regeneration, whereas omeprazole showed a negative effect on hepatic regeneration.

Sarcoidosis presenting as cold thyroid nodules: report of two cases.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.

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.

The relationship between the level of thirteen different substances and enzymes in blood and peritoneal fluid and the duration of mechanical intestinal obstruction: an experimental study on rats.

PURPOSE: The aim of this study is to analyze the relationship between the changes in blood and peritoneal fluid and the duration of mechanical intestinal obstruction. METHODS: A mechanical intestinal obstruction was surgically carried out in 52 Wistar albino rats. The blood and peritoneal fluid were sampled immediately (Group 1, n=13), and at 6 hours (Group 2, n=13), at 24 hours (Group 3, n=13), and at 48 hours (Group 4, n=13) following the procedure. RESULTS: Blood and peritoneal fluid ammonia concentrations, as well as blood aldolase activity have risen progressively over time (p<0.05), although not all pair-wise comparisons were statistically significant (P>0.05). CONCLUSIONS: Our data suggest that peritoneal fluid and blood ammonia levels and blood aldolase levels rise according to duration of the intestinal obstruction. Since the results were not available to determine cut-off levels, future research is required to confirm these results and determine whether ammonia or aldolase can be used in clinical practice to predict the presence and duration of a mechanical intestinal obstruction.

Spontaneous and traumatic intra-peritoneal perforations of hepatic hydatid cysts: a case series.

Little is known about the presentation, management, outcome, and recurrence of hydatid cyst perforations. We reviewed the charts of all patients admitted to our emergency service for 7 years to identify patients who were surgically treated for intra-peritoneal hydatid cyst perforations. Twelve hydatid cysts were identified in 7 patients (5 males; median age 22 yr; range 8-67). The perforations occurred spontaneously in 5 patients, and were the result of mild trauma in 2 patients. Diagnostic tools included ultrasound (US, n = 4), computed tomography (CT, n = 3), and diagnostic peritoneal lavage (DPL, n = 1). The cysts were treated with radical (n = 3) or conservative (n = 9) operative techniques. Intra-cavitary and intra-abdominal spaces were washed in 6 and 5 patients, respectively. The median follow-up time was 41 months (range 3-58). Indirect hemagglutination test was positive in 3 patients, but CT confirmed cyst recurrence in only 2 of these patients. Both had had large cysts and had undergone conservative therapy (endocystectomy and external drainage). An intra-abdominal recurrence was observed in a patient whose abdomen had not been washed during surgery. In conclusion, patients with hydatid cyst perforations in our study generally presented with severe abdominal findings. US, CT, and DPL may be helpful for the diagnosis. Recurrence may be related to operative technique, location of the cyst, and abdominal wash during the surgery.

A patient with metachronous gastric, colonic, and thyroid cancers: a case report.

In this paper, we discuss a 62-year-old woman who, in the course of 7 years (1994-2001), developed three cancers: adenocarcinoma of the stomach, adenocarcinoma of the cecum, and insular thyroid carcinoma, which metastasized to the retroperitoneal lymph nodes and liver. The patient died from complications related to the metastases. The results of basic genetic tests were normal. To the best of our knowledge, no other patient with the combination of these three cancers has been reported in the literature. Although patients with multiple cancers are not common, it is nonetheless important for clinicians to consider the possibility of second and third cancers in patients who were treated for a primary malignant tumor.

Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study.

The goal of this retrospective study was to evaluate factors that increase the risk of bowel necrosis and document the outcome of bowel resection in patients with strangulated hernias. We identified 102 patients (60 men, 42 women) who underwent surgical treatment for an incarcerated hernia at the Kartal Education and Research Hospital Emergency Unit between April 1997 and April 2001. Patients in group 1 required intestinal resection (n = 16), and patients in group 2 did not (n = 86). The median age of the patients was 53 years (range 3-96). Demographic and surgical data were obtained from the patients' charts and compared between the two groups. Women required bowel resections more often than men (p < 0.05). Patients older than 65 years and those with femoral or epigastric hernias required resection more often than patients younger than 65 years and those with inguinal, umbilical, or incisional hernias (p < 0.05 for all). Group 1 patients had a longer hospitalization and experienced more overall complications and wound infections than group 2 (p < 0.05 for all). In conclusion, incarcerated hernias are more common in men, but intestinal resection is required more often in women. The risk of intestinal resection is higher for patients with femoral hernias and those older than 65 years. Patients who undergo intestinal resection have a higher overall complication rate related to wound infections but not an increased risk of other complications or mortality.