LAPAROSCOPIC NISSEN ROSETTI FUNDOPLICATION IN TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE: EVALUATION OF LONG TERM CLINICAL OUTCOMES AND QUALITY OF LIFE.

The aim of this study is to evaluate outcomes of Nissen-Rossetti fundoplication in-terms of objective measures and quality of life evaluation instruments. For the period in observation, the chronic GERD patients, who had undergone LNRF surgery, were evaluated. The long-term outcome was assessed by subjectively comparing the preoperative and postoperative symptoms and Gastroesophageal reflux-Health related quality of life index. As an objective assessment of the pathological reflux, patients underwent 24-hour pH monitoring in the preoperative and postoperative period. Thirty-two patients, who met the criteria and volunteered to participate, were included in the study. The median postoperative follow-up period for the patients was 28±7.92 (16-52) months. A significant increase was observed in the quality of life scores in the postoperative period when compared to the preoperative period (p=0.001) and the DeMeester scores have decreased significantly (p=0.001). The postoperative dysphagia was observed even in the long term in most of the patients, without having a significant effect on the quality of life. In the treatment of gastroesophageal reflux disease, laparoscopic Nissen Rossetti fundoplication is an effective and successful method in achieving the desired outcome such as preventing pathological reflux, relieving the symptoms and improving the quality of life in the long term.

The relation between pure papillary and follicular variant in papillary thyroid carcinoma.

OBJECTIVE: Pure papillary thyroid carcinoma and the follicular variant papillary thyroid carcinoma are the most common subtypes of papillary thyroid carcinoma. The aim of this study was to investigate the effects of prognostic factors of these two subgroups in our series. PATIENTS AND METHODS: Histopathological type of carcinoma was retrospectively revised in 199 patients who were then divided according to such type. Patients' age and gender as well as the size and multicentricity of tumor, association with Hashimoto's thyroiditis, serum thyroglobulin and anti-thyroglobulin antibodies levels, metastatic lymph node and distant metastases status for both groups were evaluated. RESULTS: Gender, size, multicentricity of tumor, serum thyroglobulin and anti-thyroglobulin levels were similar in both groups. It was found that, although the tumor size of pure papillary thyroid carcinoma was smaller than that of follicular variant papillary thyroid carcinoma, lymph node metastases occurred more frequently when both subgroups were examined. CONCLUSION: The pathological and clinical signs of pure papillary thyroid carcinoma and follicular variant papillary thyroid carcinoma were found similar. According to these results, this study does not support the literature which claims that follicular variant papillary thyroid carcinoma is more aggressive than pure papillary thyroid carcinoma. Moreover, it could be assumed that the number of patients who are diagnosed as pure papillary thyroid carcinoma may be higher when associated with Hashimoto's thyroiditis.

Comparison of the effects of sodium nitroprusside and L-carnitine in experimental ischemia-reperfusion injury in rats.

AIM: The aim of this study was to evaluate the protective effect of sodium nitroprusside (SNP) as a nitric oxide (NO) donor and L-carnitine intraperitoneal administration to treat experimental ischemia-reperfusion (I/R) in rats. MATERIALS AND METHODS: Rats were divided into four groups, each one consisting of 10 animals. Group 1 was subjected to a sham operation. In group 2, an I/R process was applied to the rats. In group 3, SNP (5 mg/kg) and in group 4, L-carnitine (500 mg/kg) was administered in addition to the I/R process. Ileal tissue samples were obtained for analysis of tissue malonyl dialdehyde (MDA) and for histopathologic examination. RESULTS: By histopathologic examination, the I/R group showed a significant difference from the SNP and L-carnitine groups (P<.05). There was no difference between the sham, the SNP, and the L-carnitine groups (P>.05). SNP used as an NO donor produced a significant decrease in MDA levels. There was a significant difference between the MDA levels of the SNP and the I/R groups (P<.05). Also, the difference between this group and the I/R group was significant (P<.05). CONCLUSION: SNP helped to both prevent and reduce mucosal damage in terms of histological and tissue MDA levels. Since the results of the L-carnitine group and the SNP group were similar, L-carnitine was as effective as exogenous NO.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia

Aim: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. Subjects and Method: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptivemeloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded. Results: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti- inflammatory drug was also found to be significantly lower (p = 0.0001). Conclusion: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia.It thereby improves patients comfort and should be considered for use in outpatient surgery.

Objetivo: Investigar el efecto de la administración de una dosis de meloxicam de forma preventiva enel tratamiento del dolor postoperatorio en pacientes sometidos a una reparación quirúrgica de hernia inguinal bajo anestesia local. Sujetos y Métodos: Cincuenta pacientes que tuvieron una reparación de hernia inguinal bajo anestesia local durante el período de noviembre de 2005 a mayo de 2006, fueron reclutados para el estudio demodo prospectivo. Los pacientes fueron divididos aleatoriamente en dos grupos, partiendo del criterio de la administración o no administración de meloxicam de modo preventivo. Se registraron los valores de la escala visual-analógica (EVA) para el dolor postoperatoria a las 4, 8, 12 y 14 horas, así como las necesidades analgésicas de los pacientes. Resultados: No se hallaron diferencias entre los grupos en relación con la edad, el género, lalocalización y el tipo de hernia. Los valores de la EVA de los pacientes con respecto a la severidad de su dolor, fueron evaluados a las 4, 8, 12 y 24 horas, y resultaron ser significativamente más bajos en el grupo que recibió meloxicam de forma preventiva (p = 0.001, 0.0001, 0.003 y 0.0001 respectivamente). También se halló que la necesidad de un medicamento anti-inflamatorio no ester-oidal era significativamente más baja (p = 0.0001). Conclusión: La severidad del dolor postoperatorio y por lo tanto la necesidad de analgésicos, experimentaron una disminución significativa en los pacientes que recibieron meloxicam de forma preventiva. La dosis sencilla de meloxicam de forma preventiva parece ser una terapia analgésica efectiva para pacientes que han sido sometidos a reparación quirúrgica inguinal con anestesia local. Su aplicación mejora el alivio de los pacientes, y debe tenerse en cuenta su uso para la cirugía ambulatoria.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia.

AIM: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. SUBJECTS AND METHOD: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded RESULTS: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001). CONCLUSION: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.

Molecular diagnosis of pancreatic cancer.

Pancreatic ductal adenocarcinoma is a result of accumulated genetic alterations, including oncogenes such as K-ras, tumor-suppressor genes such as p53, p16 and DPC4 and genome-maintenance genes such as BRCA2, microsatellite instability and telomerase. Recent findings which characterize the molecular genetic profile of the pancreatic cancer have reshaped the nomenclature describing histological progression in pancreatic ductal tumorigenesis. K-ras mutations frequently occur early, whereas changes in the expression and genetic integrity of the p16 gene appear in intermediate lesions, and the inactivation of the p53, DPC4 genes and activation of telomerase occur late in the neoplastic progression. So far K-ras and telomerase activity have been used as molecular markers for the diagnosis of pancreatic carcinoma, whereas p53 and p16 may be a prognostic indicator of pancreatic cancer. Additional tumor-suppressor genes and the related signaling pathway such as ALK-5 are likely to be defined. In addition to the human genome project, these new advances hopefully will accelerate the development of diagnostic and screening techniques for this grave condition.

Expression of neural cell adhesion molecule in pancreatic cancer.

Neural cell adhesion molecule (NCAM) has been found to be a significant factor for survival in various solid tumors. In the present study, we examined the expression of NCAM in exocrine tumors of the pancreas by immunohistochemistry, using two monoclonal antibodies against NCAM and polysialic acid (MAB735). Expression of NCAM was seen mainly in the cytoplasm of the following cells: regenerating duct cells among neoplastic tissue, hyperplastic islet cells, intrapancreatic nerves and ganglia, as well as tumor cells. There was no reactivity with MAB735. We found a significant correlation between intense NCAM expression (i.e., expression in more than 50% of all tumor cell mass) and survival rates in tubular adenocarcinoma, particularly moderately differentiated tumors (p < 0.05). There was no statistically significant relation between NCAM reactivity and tumor stage or any of the clinicopathologic parameters described by the Japan Pancreas Society (p > 0.05). We conclude that the expression of NCAM in tubular adenocarcinoma of the pancreas, particularly in moderately differentiated tumors, has a significant impact on the overall patient survival.

Rotation ligamentoplasty for the correction of epicanthus inversus.

Epicanthus, with its various types, is characterized by an arching fold at the sides of the nose, with a concavity directed laterally. Epicanthus inversus, one of these types, which occurs with varying frequency in all races, is most common among Asians. In epicanthus inversus, the medial canthus is displaced laterally and the medial canthal depression is shallow or absent. The lower puncta is displaced laterally as well. Correction of epicanthus is easy with Z-plasties or with the four-flap technique of Mustardé. However, inverted epicanthus cannot be repaired using these techniques, as proved by others. The authors suggest rotating the medial canthal ligament during transnasal wiring to support the eversion of the laterally displaced medial lower lid, lower puncta, and surrounding skin. Eight patients with epicanthus inversus were operated and followed for at least 15 months. The results were satisfactory according to a graded scale.

Fat prefabrication using a fascial flap in the rat model.

Prefabrication of fat tissue using a fascial flap based on the superficial inferior epigastric artery was studied in rats. First, the superficial inferior epigastric fascia was transposed over the inguinal fat pad. Two weeks later fascia and fat were elevated together as a prefabricated composite flap. At this stage, a pilot study was done in ten rats and perfusion of the flaps was tested with fluorescein. After confirming fluorescein staining of the prefabricated flaps, the study continued with experimental and control groups of rats. In the experimental group, prefabricated flaps were transposed to the subcostal area. In the control group, the pedicles of the flaps were severed, creating composite grafts. These grafts were transferred to the subcostal area in the same manner as in the experimental group. One week later the flaps were re-elevated and grafts were exposed. Fluorescein tests and Indian ink microangiography were carried out. In the experimental group, the flaps were stained, while grafts in the control group were not stained. Fat and fascia were found to be viable in the experimental group, while they were necrotic in the control group on histopathological examination. Based on these findings, we can conclude that the prefabrication of fat by vascular fascia is successful and may have application in plastic surgery.

Practical do-it-yourself device for accurate volume measurement of breast.

A simple and accurate method of measuring differences in breast volume based on Archimedes' principle is described. In this method, a plastic container is placed on the breast of the patient who is lying in supine position. While the breast occupies part of the container, the remaining part is filled with water and the volume is measured. This method allows the measurement of the volume differences of asymmetric breasts and also helps the surgeon to estimate the size of the prosthesis to be used in augmentation mammaplasty.

PGP9.5 as a prognostic factor in pancreatic cancer.

The expression of PGP9.5 was evaluated using immunohistochemistry in 69 resected ductal carcinomas of the pancreas and in normal pancreatic tissue. Overexpression did not seem to differ with histological type or pathological stage. A significant negative correlation was found between overexpression of PGP9.5 and postoperative survival. Multivariate analysis also suggested PGP9.5 along with tumor stage and extrapancreatic plexus invasion as strong predictors of the outcome. This study suggests that PGP9.5 expression may be used as a marker for predicting the outcome of resection-treated pancreatic cancer patients.

Neuroendocrine-like differentiation in patients with pancreatic carcinoma.

BACKGROUND: The accurate estimation of the rate and the clinicopathologic significance of neuroendocrine-like differentiation (NED) in patients with pancreatic carcinoma have not been studied in detail. METHODS: Forty-four patients with pancreatic carcinoma who underwent surgical resection at the Department of Surgery II, Nagoya University Hospital, were included in this study. For immunostaining, antibodies against neural cell adhesion molecule (NCAM), neuron-specific enolase (NSE), synaptophysin, CD57, and chromogranin A (CGA) were used at given dilutions. At least two positive results with antibodies were considered as NED. Statistical analysis was performed by chi-square and Spearman rank correlation tests for group differences. Survival rates were calculated by the Kaplan-Meier method, and statistical significance was examined using the log rank test. Prognostic factors were tested by univariate and multivariate analyses (proportional hazards regression model). P < 0.05 was considered statistically significant. RESULTS: Of 44 patients examined, 20 showed NED. The distribution of patients with positive or negative NED in terms of age, tumor differentiation, tumor size, and the extent of tumor or lymph node metastasis showed no significant difference. The cumulative survival rates of patient groups according to NED status were then calculated, and NED positive patients showed a significantly better survival rate (P < 0.05). Univariate and multivariate analyses of those factors showed that only NED status and TNM stage were significantly related to overall survival. CONCLUSIONS: The current study suggests the significance of NED status in determining the outcome of patients with pancreatic adenocarcinoma, giving solid evidence to encourage further studies on the differentiation and origin of tumor cells in the pancreas.