Factors affecting morbidity and mortality in pancreatic injuries.

PURPOSE: Difficulties in the detection of pancreatic damage result in morbidity and mortality in cases of pancreatic trauma. This study was performed to determine factors affecting morbidity and mortality in pancreatic trauma. METHODS: The records of 33 patients who underwent surgery for pancreatic trauma between January 2004 and December 2013 were analyzed retrospectively. RESULTS: The types of injury were penetrating injury and blunt abdominal trauma in 75.8 and 24.2 % of all cases, respectively. Injuries were classified as stage 1 in 6 cases (18.2 %), stage 2 in 18 cases (54.5 %), stage 3 in 5 cases (15.2 %), and stage 4 in 4 cases (12.1 %). The average injury severity scale (ISS) value was 25.70 ± 9:33. Six patients (18.2 %) had isolated pancreatic injury, 27 (81.2 %) had additional intraabdominal organ injuries and 10 patients (30.3 %) had extraabdominal organ injuries. The mean length of hospital stay was 13.24 ± 9 days. Various complications were observed in eight patients (24.2 %) and mortality occurred in three (9.1 %). Complications were more frequent in patients with high pancreatic damage scores (p = 0.024), additional organ injuries (p = 0.05), and blunt trauma (p = 0.026). Pancreatic injury score was associated with morbidity, while the presence of major vascular injury was associated with mortality. CONCLUSIONS: Complications were significantly more common in injuries with higher pancreatic damage scores, additional organ injuries, and blunt abdominal trauma. Pancreatic injury score was associated with morbidity, while the presence of major vascular injury was associated with mortality.

Rectovaginal fistulas: five year's experience.

BACKGROUND: Rectovaginal fistula is an epithelial connection between the anterior wall of the rectum and posterior wall of the vagina. The etiology of the rectovaginal fistula can be trauma orginated from violent acts or foreign bodies as well as trauma during obstetric, gynecologic, or colorectal surgeries. The purpose of this study was to share our clinic experience and surgical management for rectovaginal fistulas. PATIENTS AND METHODS: This study was conducted at the Department of General Surgery, University of Dicle. All patients who were treated for rectovaginal fistulas between January 2005 and December 2011 were included to this study. RESULTS: There were fifteen patients in a mean age of 32 ± 9.6. The most common complains of patients were arrival of gas and stool from the vagina. The etilogy of rectovaginal fistula was most commonly obstetric trauma in our patients and three of them had anal incontinance. The mean time of hospital stay was 5 days ± 1.7. Postoperative wound infection was seen in two patients and reccurence disease occurred in two patients during the postoperative period. CONCLUSIONS: Rectovaginal fistula treatment is a challenging condition for the surgeon since anatomical relationships and different surgical conditions changes according to the paitents. Various surgical techniques are available for the management of rectovaginal fistulas according to their etiology, size, location. For the treatment of low fistulas, best results were achieved using conservative fistulectomy, layer closure, and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.

Factors affecting morbidity and mortality in hollow visceral injuries following blunt abdominal trauma.

BACKGROUND AND AIM: Hollow visceral injuries following blunt abdominal trauma are uncommon. The potential risk factors affecting morbidity and mortality are not well known. The purpose of our study was to evaluate the outcomes of hollow viscus perforation after blunt abdominal trauma. MATERIALS AND METHODS: Patient files of 56 adult patients who were treated with diagnosis hollow viscus injuries due to blunt abdominal trauma between the years 2000 and 2011 at the Dicle University Medical School General Surgery Clinic were retrospectively evaluated by analyzing the relationship between morbidity-mortality and potential risk factors. RESULTS: Fifty-six patients formed the study group, with median age of 37.5 ± 17,0 (range, 16-78) years and a significant male (80.3%) predominance. The median Injury Severity Score was 4 (1-25). The median length of hospital stay 7.5 (1-21) days. The mean age in the group with morbidity (47.1 ± 17.4) was significantly higher than the group without morbidity (34.3 ± 15.8) (p<0.05). Also, re-operation (p=0.0013), treatment modality (p=0.037), cause of injuries (0.0046) were other factors that affect morbidity. CONCLUSIONS: These findings suggest that factors affecting morbidity were cause of injuries, re-operation and treatment in patients with hollow viscus injury caused by blunt abdominal trauma. And factors affecting mortality were the injured organ, the presence of shock and median injury severity score.

The protective effect of ellagic acid on lung damage caused by experimental obstructive jaundice model.

AIM: This study aimed to investigate protective effects of ellagic acid on lungs in an experimental obstructive jaundice model. METHODS: Four groups were established, each consisting of ten randomly selected rats: Group 1: sham, Group 2: ellagic acid, Group 3: obstructive jaundice, and Group 4: obstructive jaundice + ellagic acid. Ellagic acid was administered orally at a dose of 60 mg/kg/day to group 2 and 4. The animals were sacrificed eight days later. The total oxidative status and the total antioxidant capacity in their lung tissue were determined, and malondialdehyde levels in their blood were measured. Histopathological changes in the lungs were examined. RESULTS: In the obstructive jaundice group treated with ellagic acid, there was a decrease in malondialdehyde levels and a reduction in the total oxidative status and the oxidative stress index, whereas the total antioxidant capacity increased (p < 0.001). The histopathological examination showed that neutrophil leukocyte infiltration and edema formation decreased and destruction of lung parenchyma disappeared following the treatment with the ellagic acid (p < 0.05). CONCLUSION: This study shows that ellagic acid has a protective effect against oxidative damage in lung tissue in obstructive jaundice.

Laparoscopic salvage for malfunctioning of peritoneal dialysis catheters.

AIM: The aim of this study was to emphasize the efficacy of the laparoscopic surgical method performed for elimination of catheter-induced mechanical complications developing in CAPD patients. METHODS: Medical records of 31 patients who had undergone CAPD catheter implantation at the Dicle University Medical Faculty Hemodialysis Unit between January 2001 and June 2012 were examined retrospectively. Double-felted spiral Tenckhoff catheters were used in all patients for peritoneal access. RESULTS: We performed a retrospective review of 31 patients who, over an 11-year period, underwent revision of a peritoneal dialysis catheter using laparoscopy. Chronic renal failure requiring dialysis occurred in 31 patients (12 males and 19 female). Ages ranged from 13 to 77 years (mean age 35.8 years). CONCLUSION: As a conclusion, CAPD is currently a choice to be frequently used in patients with ESRD. In the treatment of CAPD-associated mechanical catheter complications laparoscopic method may be preferred because of patient comfort, short hospital stay, and lesser postoperative complications.