Minimal effective dose of povidone-iodine in abdominal surgery Our clinical experience.

UNLABELLED: The aim of this study is to evaluate the thyroid function tests in order to examine whether 10 % of Povidone-Iodine(PI), the medication we applied in 1/5 ratio diluted with 0.9 %NaCl, joins the systemic circulation during clean contaminated, contaminated and dirty operations for solid organ hydatid cysts in abdominal area to avoid abscess formation and spreading. 7 men and 6 women were included to the present study, prospectively. The mean age was 33.69(± 13.49). TSH, free T3 (fT3) and free T4 (fT4) hormone levels were measured before the operation and at the third day of postoperative period. Amount of used povidone-iodine for patients was recorded. As a result of statistical analysis applied, the preoperative and post operative values were not significantly different regarding with the measured hormone levels (preTSH vs postTSH: p= 0.984; prefT3 vs postfT3: p= 0.101; prefT4 vs postfT4: p=0.146). Thus, it has been shown that the dose we used is effective, and it does not enters at all or at quite low levels into the systemic circulation. Patients whom this application performed, abscess and intestinal adhesions have not been observed in our clinical experience. We recommend the use of suggested doses of Povidone-Iodine in the presence of intraabdominal perforation and abscess or in cases such as carrying a risk of cyst spreading to intraabdominal area in hydatid cysts. KEY WORDS: Povidone-iodine, Surgical adhesions, Surgical wound infections, Thyroid function tests.

Surgical treatment of hepatic hydatid cysts A retrospective analysis of 425 patients.

BACKGROUND: We aimed to retrospectively analyze patients who underwent surgical treatment in our clinic for hydatid cysts in terms of the surgical methods implemented and their results. METHODS: Archival records of the patients who underwent surgery for the treatment of hydatid cysts between 2007 and 2014 were analyzed retrospectively. RESULTS: The records of 425 patients who underwent surgery with varying ages of 16 to 88 years (mean: 44.5) were obtained. Among the patients, 33.9% (n=144) were male and 66.1% (n=281) were female. The most frequent symptoms were abdominal pain (46.4%) and dyspepsia (30.9%). About 79.5% of the patients had hydatid cysts in their livers, and 66.8% of these cysts were on the right lobe of the liver. Surgical intervention was performed on 513 cysts. The average diameter of these cysts was 8.3 cm. About 85.5% (n= 438) of the interventions implemented were partial cystectomy. Laparotomy was performed through the right subcostal incision on 81% (n=345) of the patients who underwent conventional surgery. The most frequently encountered complication was biliary fistula. The mortality rate was 0%. CONCLUSIONS: The results showed that most of the cases were uncomplicated isolated hepatic hydatid cysts frequently found on the right lobe of the liver. The most frequently implemented surgical procedure was partial cystectomy. This procedure was simple, fast and applicable for uncomplicated hepatic hydatid cysts. KEY WORDS: Hepatic hydatid cyst, Mortality, Partial cystectomy.

An uncommon cause of pneumobilia: blunt abdominal trauma.

Pneumobilia is described as occurrence of free air in the gallbladder or biliary tree. There are a number of causes of pneumobilia, including surgically created biliary enteric fistula, instrumentation of the bile duct on endoscopic retrograde cholangiopancreatography, emphysematous cholecystitis, and pyogenic cholangitis. Pneumobilia has also occurred following blunt abdominal trauma, but to date, no more than five cases of such injury have been reported in the literature. In this report, we present a patient struck by a motor vehicle with traumatic pneumobilia following blunt trauma to the abdomen, which was managed conservatively.

A case series of 46 appendectomies during pregnancy.

OBJECTIVE: Among appendicitis patients pregnant ones occupy only a small proportion. Still there are difficulties in the diagnosis and management of the acute appendicitis in pregnant population. We tried to find answers to these difficulties with our acute appendicitis cases in pregnant patients. STUDY DESIGN: This study involved 46 pregnant patients who received an operation following diagnosis of acute appendicitis in our clinic from 2006 to 2009. Data were collected retrospectively from medical records. Age, time delay to diagnosis, leukocyte count (WBC), gestational age, gestational history, morbidity-mortality and pathology results were evaluated. RESULTS: The mean age of patients, gestational age and number of prior pregnancies were 26, 21 and 2.6, respectively. The amount of time spent in the hospital, from presentation of first symptom to admission, was approximately 40 hours (range 6-120). The mean time from admission to operation was 5.89 (range 1-32) hours. The perforation rate among our cases was 21%. The negative appendectomy rate was 13%. The perforation rate was associated with advanced gestational age and delayed admission to the hospital (p ≤ 0.001 and p = 0.027, respectively). CONCLUSION: The diagnosis of appendicitis in pregnancy is difficult, and the perforation rate is high. Particularly in term pregnancies, we recommend performing appendectomy immediately after cesarean section.

Protective effects of Nigella sativa on intestinal ischemia-reperfusion injury in rats.

BACKGROUND: In previous studies, it has been demonstrated that Nigella Sativa (NS) has protective effects against ischemia reperfusion injury on various organs. However, its protective effects on intestinal tissue against ischemia reperfusion injury are unclear. We aimed to determine whether NS prevents intestinal ischemia-reperfusion injury in rats. MATERIALS AND METHODS: Thirty rats were divided into three groups as sham (group 1), control (group 2), and NS-treatment group (group 3). All rats underwent intestinal ischemia for 60 min followed by a 60-min period of reperfusion. Rats were intraperitoneally infused only 0.9% saline solutions in group 2. Rats in the group 3 received NS (0,2 mL/kg) intraperitoneally, before ischemia and before reperfusion. Total antioxidant capacity (TAC), catalase (CAT), total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in ileum tissue were measured. Also, ileum tissue histopathology was evaluated by a light microscope. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in group 2 (p <.01). TAC and CAT activity levels in ileum tissue were significantly higher in group 3 than in group 2. TOS, OSI, and MPO in ileum tissue were significantly lower in group 3 than group 2 (p <.05 for TOS and MPO; p < .01 for OSI). Histological tissue damage was milder in the NS treatment group than in the control group. CONCLUSION: Our results suggest that NS treatment protected the rat's intestinal tissue against intestinal ischemia-reperfusion injury.

Protective effects of Nigella sativa against ischemia-reperfusion injury of kidneys.

BACKGROUND: Ischemia-reperfusion, commonly seen in the fields of trauma surgery and renal transplantation, is a major cause of acute kidney injury and is associated with significant morbidity and mortality. The protective effects of Nigella sativa against ischemia-perfusion damage to various organs have been previously documented. However, its protective effects on kidney tissue against ischemia-reperfusion injury are unclear. In this study, we aimed to examine the effect of Nigella sativa in modulating inflammation and apoptosis after renal I/R injury. MATERIALS AND METHODS: Thirty male Wistar-albino rats were divided into three groups: sham-operated, ischemia-reperfusion, and ischemia-reperfusion + Nigella sativa. Rats in the third group were given Nigella sativa 6 h prior to ischemia-reperfusion and at the beginning of reperfusion. All rats except those in the sham-operated group underwent 45 min of bilateral renal ischemia followed by 45 min of reperfusion. Blood samples and liver tissues were harvested from the rats, and then rats were sacrificed. Serum urea and creatinine levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidant status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in kidney tissue and blood were measured. Kidney tissue histopathology was also evaluated. Results. Nigella sativa was effective in reducing serum urea and creatinine levels as well as decreasing the tubular necrosis score. Nigella sativa treatment significantly reduced OSI and TOS levels and increased TAC levels in both kidney tissue and blood. CONCLUSION: The observed differences seem to demonstrate the protective effect of Nigella sativa against renal I/R injury in rat kidneys.

The effect of caffeic acid phenethyl ester (CAPE) against cholestatic liver injury in rats.

OBJECTIVES: Caffeic acid phenethyl ester (CAPE) has been subjected to considerable investigations that have revealed its antioxidant and anti-inflammatory activities in different conditions. But there is not a previous investigation about its effect on cholestatic liver injury. The aim of this study was to investigate the effect of CAPE in rat liver against cholestatic liver injury induced by bile duct ligation. METHODS: Swiss-albino rats were recruited in the study as follows; Group 1 rats subjected to simple laparotomy known as the sham group; Group 2 rats subjected to bile duct ligation (BDL); Group 3 bile duct ligated rats treated with CAPE. The third group received CAPE (10 micromol/kg) intraperitoneally daily throughout 14 d. RESULTS: Data showed a decrease in gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase levels (ALT) of the CAPE treated rats, compared with BDL group (P < 0.001, P < 0.01, and P < 0.02, respectively). In the CAPE treated rats, tissue levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were significantly lower than that of the BDL group (P < 0.001). The levels of glutathione (GSH) in CAPE treated rats were significantly higher than that of BDL group (P < 0.001). In CAPE treated group, the levels of interleukin-1alpha (IL-1alpha) and interleukin-6 (IL-6) were significantly lower than that of BDL group (P < 0.03, P < 0.02, respectively). Administration of CAPE in the rats with biliary obstruction resulted in inhibition of necro-inflammation. CONCLUSION: These results suggest that treatment of CAPE maintains antioxidant defenses, reduces oxidative liver injury, cytokine damage, and necro-inflammation in bile duct ligated rats. Thus, CAPE seems to be a promising agent for the attenuation of cholestatic liver injury.

The effects of Nigella sativa on bile duct ligation induced-liver injury in rats.

Nigella sativa (NS) has been shown to have antioxidant and antiinflammatory activities in different conditions. The goal of this study was to evaluate the effects of NS on cholestatic liver injury in rats. Thirty rats were recruited in the study as follows: Group 1, Bile duct ligation (BDL) (n = 10); Group 2, BDL plus NS (n = 10); and Group 3, Sham (n = 10). Bile duct ligated group received 0.2 mL kg(-1) dose of NS intraperitoneally daily throughout 14 days. Liver damage and cholestasis were determined by the biochemical and the pathologic examination. Data showed a decrease in gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activities of the NS treated rats when compared with BDL group (p < 0.001 for GGT and p < 0.05 for others). The NS treated rats' tissue levels of total oxidant status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) were significantly lower than that of the BDL group (p < 0.01 for all). Increases in total antioxidant capacity (TAC) and catalase (CAT) levels were statistically significant in the NS treated rats compared to BDL group (p < 0.01 for both). On the other hand, administration of NS in the rats with biliary obstruction resulted in inhibition of necro-inflammation. These results indicate that NS exerts a therapeutic effect on cholestatic liver injury in bile duct ligated rats possibly through attenuation of enhanced neutrophil infiltration and oxidative stress in the liver tissue.

Purified micronized flavonoid fraction ameliorates the injury of spleen and ileum secondary to hepatic ischemia-reperfusion in rats.

BACKGROUND: Flavonoids have been subjected to considerable investigations due to their antioxidant and anti-inflammatory properties. Yet the effects of flavonoids on the ileum and spleen against hepatic ischemia-reperfusion injury have so far not been addressed. AIMS: We aimed to investigate whether micronized purified flavonoid fraction (MPFF) protects the ileum and spleen against hepatic ischemia-reperfusion injury. METHODS: Rats were subjected to hepatic ischemia by clamping the hilar area of the rats for 60 min, followed by 60 min of reperfusion. Rats in the treatment group were treated with MPFF (80 mg/kg/day) by gavage for 3 days before surgery, 30 min prior to ischemia and just before the reperfusion. After the reperfusion period, all rats were sacrificed. Ileal and splenic tissues were taken for histological evaluation and determination of the total antioxidant capacity (TAC), catalase, total oxidant status (TOS), oxidative stress index (OSI) and myeloperoxidase (MPO) levels. RESULTS: TAC levels in the splenic tissue and intestinal tissue were significantly higher in the treatment group than in the control group (P < 0.01 for both). TOS, OSI, and MPO in splenic tissue (P < 0.01, P < 0.05, and P < 0.05, respectively) and intestinal tissue (P < 0.01, P < 0.01, and P < 0.001, respectively) were significantly lower in the treatment group than in the control group. Histological tissue damage of intestinal tissue was milder in the treatment group than in the control group. CONCLUSION: The results of this study indicated that MPFF pretreatment significantly limited the injury to the small intestine and spleen induced by hepatic ischemia-reperfusion in rats.

A rare cause of difficulty with sexual intercourse: large retroperitoneal leiomyoma.

INTRODUCTION: The prevalence of sexual dysfunction is high among women; however, sexual dysfunction secondary to anatomical deformity in women is rare. In addition, primary retroperitoneal leiomyomas are very rare clinical conditions. AIM: To present a case with sexual dysfunction secondary to anatomical deformity. METHODS: In this article, we report the case of a large retroperitoneal leiomyoma causing sexual dysfunction. RESULTS: After the surgical removal of the large retroperitoneal mass, previous intercourse difficulties had been resolved. CONCLUSIONS: Retroperitoneal tumors may obstruct the vagina by congesting the pelvic area and may be considered as a possible cause of female sexual dysfunction.