Prognostic value of Prognostic Nutritional Index (PNI) for 5-year recurrence-free survival in surgically resected gastrointestinal stromal tumors.

BACKGROUND: Recent studies have investigated the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and prognostic nutritional index (PNI) on prognosis for various malignancies. However, the value of these markers in determining the prognosis for gastrointestinal stromal tumors (GIST) remains controversial. We investigated the effect of NLR, PLR, SII, and PNI on 5-year recurrence-free survival (RFS) in patients with surgically resected GIST. MATERIALS AND METHODS: We retrospectively analyzed patients (n=47) who had undergone surgical resection for primary, localized GIST at a single institution between 2010 and 2021. The patients were divided into two groups according to the recurrence status in the 5-year period as 5-year RFS(+) (patients with no recurrence (n=25) and 5-year RFS(-) (patients with recurrence (n=22) groups. RESULTS: In univariate analyses, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), tumor localization, tumor size, PNI, and risk category were significantly different between the RFS(+) and RFS(-) groups while NLR, PLR, SII were not. Multivariate analyses revealed that only the tumor size (HR =5.485, 95% CI: 0.210-143.266, p=0.016), and PNI (HR= 112.020, 95% CI: 8.755-1433.278, p<0.001) were independent prognostic factors for RFS. The patients with a high PNI (≥46.25) had a higher 5-year RFS rate than the patients with low PNI (<46.25) (95.2% to 19.2%, p<0.001). CONCLUSION: A higher preoperative PNI is an independent positive predictor for 5-year RFS for patients with surgically resected GIST. However, NLR, PLR, and SII have no significant effect. KEY WORDS: GIST, Prognostic Nutritional Index, Prognostic Marker.

Hemostatic effects of traditional Inula viscosa and Capsella bursa-pastoris plant mixture extract on rat liver parenchymal bleeding model.

BACKGROUND: Failure to achieve effective bleeding control and problems related to transfusion in liver surgery are the most common causes of post-operative mortality and morbidity. Various methods/drugs including topical hemostatic agents have been em-ployed for bleeding control in liver surgery. This study was aimed to investigate the hemostatic properties of the herb mixture extract of Inula viscosa and Capsella bursa-pastoris (IvCbp) in rat liver laceration model, which have been traditionally used as antiseptic and hemostatic agents public in Hatay/Tukey. METHODS: Thirty rats were divided into three groups equally and blood samples were taken from all rats for preoperative hemoglobin (Hb) measurements. Then, the standard liver resection model was applied to all rats. Sponge for the first rat group, Ankaferd Blood Stopper® Trend-Tech for the second rat group and IvCbp plant extract mixture for the third group were applied to resection areas for 3 minutes. Liver samples of all rats were evaluated in terms of inflammation and necrosis intensity on the 5th post-operative day. RESULTS: Post-operative Hb values were found as 11.0±1.1 g/dL in the sponge group, 11.9±2.0 g/dL in the Ankaferd group, and 14.1±1.2 g/dL in the IvCbp herb mixture group (p<0.001). In the histopathological examination, less necrosis was observed in the herb mixture group compared to the sponge and Ankaferd groups (p=0.001). In addition, no statistically significant necrosis difference was observed between sponge and Ankaferd groups. While less inflammation was observed in the herb mixture group compared to the other groups, Ankaferd group had the highest inflammation score (p<0.001). CONCLUSION: IvCbp herb mixture extract group provide effective hemostatic control, caused less Hb decrease and resulted in less inflammation and necrosis compared to Ankaferd and sponge groups in a rat liver resection model.

CREB1 and PPAR-α/γ Pathways in Hepatic Ischemia/Reperfusion: Route for Curcumin to Hepatoprotection.

Background: Hepatic ischemia/reperfusion injury is a major problem that can exacerbate complications, particularly in liver transplantations. Objectives: This study aimed to investigate the cellular mechanisms of ischemia/reperfusion injury and hepatoprotection by curcumin. Methods: Wistar albino rats were divided into four groups as Control, Sham, I/R, and Cur+I/R. Hepatic ischemia/reperfusion was induced in I/R and Cur+I/R animals, the latter of which was also given 50 mg/kg/day of curcumin for 14 days. Liver aminotransferases and the transcription regulators of inflammation (RelA, IκB, PPAR-α, PPAR-γ, CREB1) were examined along with the histological examination. Results: Hepatic ischemia/reperfusion was found to disrupt hepatic microstructure and downregulate PPAR-α, PPAR-γ, and CREB1 transcripts. Curcumin supplementation in hepatic ischemia/reperfusion recovered the structural organization and promoted the hepatocyte regeneration while increasing expressions of PPARs and CREB1. RelA and IκB were found unaltered, possibly due to the crosstalk between targeted transcripts by ischemia/reperfusion and curcumin. Conclusions: In sum, PPAR-α/γ and CREB1 were involved in hepatic ischemia/reperfusion and, moreover, were detected to be stimulated by curcumin. PPAR and CREB pathways were found to provide a route to hepatoprotection for curcumin supplementation as evidenced by the microstructural improvement.

Perioperative Effects of Induction with High-dose Rocuronium during Laparoscopic Cholecystectomy.

OBJECTIVE: We aimed to investigate the effects of high-dose rocuronium administration on intra-abdominal pressure (IAP) and surgical conditions during anaesthesia induction and laparoscopic cholecystectomy anaesthesia induction, respectively. Further, we aimed to determine postoperative nausea and vomiting (PONV) and pain scores following the laparoscopic cholecystectomy. METHODS: Patients with American Society of Anesthesiologists (ASA) score of I-III, aged 18 to 75 years and who were scheduled for surgery under general anaesthesia were included in the study. Patients were randomised and a high-dose of 1.2 mg kg-1 rocuronium was given to Group A and 0.6 mg kg-1 rocuronium to Group B. The intraoperative train of four (TOF) ratio and post-tetanic count (PTC) were measured. Surgery was initiated with a low IAP of 7 mmHg. The surgeon evaluated surgical conditions with a 4-step surgical field scale and increased the IAP when necessary. PONV at 4, 12 and 24 hours and postoperative pain at 2 and 24 hours and 3 days were evaluated. RESULTS: There were no significant differences in the demographic and haemodynamic parameters between the groups. In high-dose rocuronium Group A, IAP values were significantly lower in the first 20 minutes compared to Group B. The duration of operations was significantly shorter in Group A (29.00±7.39 minute vs. 34.63±12.00 minute, p=0.044). PONV in the first 12 hours was significantly lower in Group A (p<0.05). CONCLUSION: High-dose rocuronium-induced deep neuromuscular block helped perform laparoscopic cholecystectomy operations with lower values of IAP compared to a normal dose rocuronium. It also shortened duration of operation and reduced PONV and pain.

Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen.

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated. METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013-2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared. RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05). CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

Treatment of colorectal injuries in the civil war and the factors affecting mortality.

AIM: Colorectal injuries are one of the most common causes of mortality in war. Mainstay treatment of these injuries include primary repair or stoma creation. METHODS: Clinical data of the patients were evaluated retrospectively. Time from injury to hospital admission, method of treatment, the colorectal area affected, injury severity score ISS, hemodynamic instability, and mortality rate were determined. RESULTS: Of the 61 patients included in the study. Mean time from injury to hospital admission was 160±19 minutes. The injury was in the right colon in 24 patients 39.3%, in the left colon in 18 29.5%, and in the rectum in 19 31.2% patients. Median ISS value of 61 patients was 16, IQR 5. Mortality and complication rates were higher in patients with hemodynamic instability and stoma requirement was also higher in this group p<0.05. Total mortality occurred in 15 24.5% patients. Of these, 10 66.6% patients had hemodynamic instability. DISCUSSION: Hemodynamic instability is the most important factor affecting the mortality and the treatment method in wartime colorectal injuries. CONCLUSION: We believe that in victims of war with colorectal injuries, surgical intervention before the development of hemodynamic instability may reduce the rate of mortality and stoma requirement. KEY WORDS: Colorectal injury, Firearm injury, Hemodynamic instability, Stoma.

Does cyclin E and p57kip2 expression have prognostic and survival value in colorectal adenocarcinoma?

INTRODUCTION: Colorectal cancer is still one of the main causes of cancer death in the world. There is a continous need for novel biomarkers for diagnose, treatment modalities and follow-up. Cyclin E and p57KIP2 as the positive and negative regulators of cell cycle seem to be an important target for investigations. MATERIALS AND METHODS: In a retrospective setting, primary colorectal adenocarcinoma cases examined in Mustafa Kemal University, School of Medicine, Pathology Department between 2008-2015 were reviewed. Immunohistochemical expressions of cyclin E and p57KIP2 in 80 pairs of colorectal carcinoma and adjacent normal mucosal tissues were evaluated and the findings were compared with clinicopathological parameters and survival time. RESULTS: There were no statistically significant difference between two groups both in cyclin E and p57KIP2 stained tissues (P>0.05). There were 40 (50%) patients in high-expression group and 40 (50%) patients in low-expression group for cyclin E. p57KIP2 was negative in 55 (68.75%) patients and positive in 25 (31.75%) patients. There were no statistically significant relation between p57KIP2 and cyclin E expressions with clinicopathologic parameters defined as age, gender, lymphovascular invasion, perineural invasion, depth of invasion, nodal involvement, emergency in operation, perforation before operation and overall survival except that there was significant relation between p57KIP2 expression and histological grade (P=0.012). CONCLUSIONS: Immunohistochemical studies of cyclin E and p57KIP2 should be performed with larger series of patients supported by more detailed technical research methods to be candidates as predictive markers for treatment modalities and prognostic factors.

Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy.

OBJECTIVE: To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. DESIGN: A prospective, randomized, double-blinded clinical study. SETTING: Operating room, postoperative recovery area, and ward. PATIENTS: In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. INTERVENTION: The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. MEASUREMENTS: The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. MAIN RESULTS: The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. RESULTS: The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. CONCLUSIONS: TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption.

Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital?

BACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality. METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality. RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked. CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced.

The Analysis of Mean Platelet Volume and Platelet Distribution Width Levels in Appendicitis.

We aimed to analyze the diagnostic value of mean platelet volume and platelet distribution width, which are also known as the markers of platelet count, in acute and perforated appendicitis. The data of 202 patients who applied to general surgery clinic in Mustafa Kemal University Hospital from 2007 to 2012 with acute appendicitis were analyzed retrospectively. The findings were separated to two groups due to the perforation status (perforated vs. non-perforated). Age, sex, leukocyte, hemoglobin, hematocrit, mean platelet volume, and platelet distribution width were examined. The mean age of the patients was 35.8. Twenty-one of all cases were perforated appendicitis (10.4 %), and the rest was acute appendicitis (non-perforated) (n = 181, 89.6 %). The mean platelet volume value was 9.8 ± 2.1 fL; mean thrombocyte count, 340.9 × 10(9)/L; and mean platelet distribution width value, 18.3 %. There were statistically significant differences between sex and age, hemoglobin, hematocrit, leukocyte, mean platelet volume, and platelet distribution width. There was a positive correlation between mean platelet volume, platelet distribution width, and platelet. Age, leukocyte, platelet, mean platelet volume, and platelet distribution width were higher in cases with perforation as a comparison with non-perforated cases. We think that mean platelet volume and platelet distribution width may be valuable markers to detect the risk of perforation in early periods of acute appendicitis.

Comparison of surgical procedures and percutaneous drainage in the treatment of liver hydatide cysts: a retrospective study in an endemic area.

INTRODUCTION: Surgical procedures are still the golden standard option in the treatment of liver cystic echinococcosis. However, minimal invasive technics like percutaneous drainage are rising trends. We aimed to compare the efficacy of surgical and percutaneous options in the treatment of liver hydatidosis in an endemic area. METHODS: Patients who underwent surgical or percutaneous procedures for hydatid disease between January 2007 and December 2012 were retrospectively evaluated. Recurrence rates, hospital stay time, and related factors were analyzed. RESULTS: There were 44 (35.5%) male and 80 (64.5%) female patients in this study. Eighty two patients (Group I) had undergone surgery (66.1%) and 42 patients (Group II) had undergone percutaneous drainage (33.9%). The mean cyst size was 7.28 ± 2.51 cm in Group I and 8.76 ± 3.30 cm in Group II. Nine recurrences (7.3%) were detected during study. Five of the recurrences were in Group II (11.9%) and four (4.9%) of them were in Group I. The mean length of hospital stay of all patients was 5.42 ± 3.16 days. DISCUSSION: Percutaneous drainage techniques can be a good alternative to surgery in selected patients. In complicated cases like cystobiliary fistula, surgery is superior to percutaneous approaches. The hospital stay time, recurrence rate and postoperative complications were not enhanced when compared to percutaneous treatment in our study. Despite all controversy about the low morbidity after percutaneous treatment, surgical approach is still a preferable option in patients with liver hydatidosis when it is performed by experienced surgeons.

Relationship between the resistance genes to quaternary ammonium compounds and antibiotic resistance in staphylococci isolated from surgical site infections.

BACKGROUND: We aimed to investigate the prevalence of disinfectant resistance genes (qacA/qacB,qacC) and the aminoglycosides resistance genes [(aac(6')aph(2''),aph(3')-IIIa,ant(4')-Ia)] in both S. aureus and coagulase-negative staphylococcal strains (CoNS) isolated from surgical site infections. MATERIAL AND METHODS: Totally, 130 staphylococcal strains isolated from surgical site infections between January 2012 and February 2013 were included in the study. The PCR technique was employed to verify any presence of methicillin resistance gene (mecA), aminoglycoside resistance genes [(aac(6')/aph (2''), aph(3)-III a ant (4')-1a)], and disinfectant resistance genes (qacA/qacB,qacC) in staphylococci. RESULTS: MecA gene was determined in 58 (44.6%) of 130 staphylococcal isolates. A total of 28 (73.7%) of 38 S. aureus isolates were found to be positive for the mecA gene, and 4 (12.9%) of 31 isolates sensitive to amikacin were sensitive to methicillin. Eighteen (47.4%) of 38 amikacin-resistant S. aureus isolates were found to be positive for qacA/qacB genes and 11 (8.9%) of them were positive for qacC gene. Both mecA and qacA/qacB genes were found to be positive at the same time in 19 amikacin-resistant S. aureus strains. Seven (18.4%) S. aureus isolates were determined to be positive for qacA/qacB and qacC genes. Frequency of qacA/B genes was found to be 47.4% among amikacin-resistant S. aureus strains, while qacC gene was found to be 28.9% (p<0.05). The ratio of qacA/B and qacC genes in CoNS was found to be 37.9% and 20.7%, respectively (p<0.05). CONCLUSIONS: Quaternary ammonium resistance genes were found to be positive at a remarkable ratio in the staphylococcal isolates from surgical wounds. Especially, the high rates of aminoglycosides and methicillin-resistance gene was remarkable in S. aureus isolates. Quaternary ammonium resistance genes were found to be positive.

Addition of ketamine to propofol-alfentanil anesthesia may reduce postoperative pain in laparoscopic cholecystectomy.

OBJECTIVE: The aim of this study was to assess whether intravenous anesthesia supplemented with ketamine reduces postoperative pain after elective laparoscopic cholecystectomy. MATERIALS AND METHODS: Forty patients were enrolled and randomized 1:1 into one of 2 groups: the propofol group (received propofol and alfentanil supplemented with saline) and the ketamine group (received propofol and alfentanil with ketamine). The study was double-blind. The number and amount of the intraoperative additional alfentanil doses were recorded. Pain assessments and cumulative analgesic consumption at postanesthesia care unit (PACU) admission, PACU discharge, postoperative 24th hour, and hospital discharge were recorded. RESULTS: The visual analog scale scores at PACU admission, PACU discharge, postoperative 24th hour, and hospital discharge were significantly lower in the ketamine group than the propofol group. The pain visual analog scale ≥ 75 at the postoperative 24th hour for the propofol group was also significantly lower (P<0.035) than that of the ketamine group. The difference in analgesic consumption between groups was statistically significant (P<0.001). CONCLUSIONS: Our study showed that ketamine supplemented with propofol and alfentanil produced better analgesia intraoperatively and postoperatively and decreased analgesic consumption compared with the propofol group after laparoscopic cholecystectomy.

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

[Late-onset traumatic rupture of the diaphragm: two case reports]. / Geç dönem saptanan travmatik diyafram yirtigi: Iki olgu sunumu.

Ruptured diaphragm as a result of blunt thorax or abdominal trauma can present acutely or late in the disease. Symptoms may be nonspecific and diagnosis can easily be missed. Patients may present with dyspnea, chest pain or cough. Chest radiograph, CT scan, and MRI are the primary diagnostic tools. Clinicians must have a high index of suspicion for prompt diagnosis, especially in patients with a history of trauma to the abdomen or thorax. The only treatment in diaphragm rupture is surgery. We report two cases of traumatic diaphragm ruptures presenting years after the trauma.

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study.

BACKGROUND: Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 µg/kg) or desflurane (4%-6%) and alfentanil (20 µg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.

Effect of propolis on healing in experimental colon anastomosis in rats.

INTRODUCTION: Propolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats. METHODS: Forty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured. RESULTS: When bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference. CONCLUSION: Propolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.

Morganella morganii-associated arthritis in a diabetic patient.

This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

A giant serous cystadenoma developing in an accessory ovary.

BACKGROUND: Accessory ovaries are rare anomalies and cysts arising from accessory ovaries are extremely rare. Their reported incidence is 1/29,000-1/700,000. Establishing the diagnosis preoperatively is difficult. Radiologic methods are usually inadequate in recognizing the origin of these tumors. Thus, they are usually confused with other intraabdominal tumors. CASE: A 22-year-old nulliparous girl presented with abdominal pain and tumoral growth for 1.5 years. Abdominal ultrasound and computed tomography revealed a 33 x 26 x 15 cm cystic mass filling the abdominal cavity. The preoperative diagnosis was a mesenteric cyst. Diagnostic laparotomy revealed a giant cystic mass arising in an accessory ovary. The left tuba and fimbrias were adhered to the cyst. The tumor was totally removed and fimbrioplasty performed. CONCLUSION: In spite of being rare entities, paraovarian anomalies should be considered in the differential diagnosis of intraabdominal tumors, especially when the origin is not identified by radiologic means. CASE: A 22-year-old single, nulliparious female was admitted to our hospital with abdominal pain, nausea and a growing abdominal swelling since 1.5 years. A tumoral mass was palpated on physical examination. Abdominal ultrasound and computed tomography revealed a 33 x 26 x 15 cm cystic mass filling the abdominal cavity. The origin of the tumor could not be detected. Operation revealed a giant cystic mass arising from an accessory ovary. Histopathologic diagnosis was serous cystadenoma. CONCLUSION: Ovarian or accessory ovarian pathologies must be considered in the differential diagnosis of intraabdominal tumors, especially in young female population.

[Fournier's gangrene caused by Candida albicans]. / Candida albicans'a bagli Fournier gangreni.

Fournier's gangrene characterized by fulminant necrotizing fasciitis of the perineal, genital or perianal regions, is generally caused by aerobic and anareobic bacteria. Although it is thought to be an idiopathic process, Fournier's gangrene has been shown to have a predilection for patients with diabetes, long term alcohol misuse and immunocompromised patients. The focus of infection is usually located in the urinary tract, lower gastrointestinal tract or skin. The development and progression of the gangrene is often fulminating and can rapidly lead to multiple organ failures and death. Here, we present a Fournier's gangrene case caused by Candida albicans. A 59-year-old woman was admitted to hospital with the complaint of swelling on the right thigh following a trauma occurred three weeks ago. Her history revealed that she had been hospitalized previously for four times due to diabetes mellitus, essential thrombocytopenia, chronic disease anemia and hypertension. Right trochanteric fracture was detected and the patient was taken under surgical debridement with the pre-diagnosis of secondary anaerobic soft tissue infection. Empirical treatment was started with cephalosporin and metronidazole. Since wo- und and blood cultures revealed C. albicans as the primary microorganism, fluconazole was added to the therapy. However, the patient died on the post-operative 25th day because of multi-organ disfunction secondary to fungal sepsis. This case has been reported to emphasize that yeasts should be considered as pathogenic agents in diabetic patients with gangrene.