Evaluation of incidental thyroid cancer in patients with thyroidectomy.

OBJECTIVES: Variations such as communications between median nerve and musculocutaneous nerve or in their abnormal branching pattern constitute a major concern in clinical and surgical field. Knowledge of these variations not only provides the clinician with a proper interpretation of the case, but also minimizes the complication in surgical approaches in this region. METHOD: We examined 50 isolated upper limbs to investigate the possible incidences of various types of communications between these two neighbouring peripheral nerves. RESULT: Twenty-eight per cent of limbs were found to have communication between these two nerves. When categorized according to Venieratos and Anagnostopoulou's classification method, 11 out of 14 cases (79%) showed type I communications, two out of 14 (14%) showed type II and the remaining one (7%) showed type III communication pattern. CONCLUSION: Prior knowledge of communications between these two neighbouring nerves, both in terms of their incidences and pattern of communications, may be of considerable significance to neurologists and orthopaedicians in dealing with nerve entrapment syndromes in the upper limb of patients.

Gallstone ileus with a giant stone and associated multiple stones.

Gallstone ileus is an uncommon cause of small bowel obstruction. Gallstone ileus accounts for only about 1-3 % of cases of mechanical obstructions of the small bowel. It usually occurs in the elderly with a female predominance and may result in high mortality rates. The diagnosis is difficult and early diagnosis reduces the mortality. Terminal ileum is the most common site of gallstone impaction. We report a case of gallstone ileus in an 81-year-old female patient who was admitted to our clinic for abdominal pain, vomiting and constipation. The ultrasonography of abdomen revealed a decrease in bowel motion, and dilated bowel segments. Intraoperatively, a giant gallstone and associated multiple stones were found in the ileum 80 cm from the ileocecal valve and extracted from a longitudinal enterotomy (Fig. 4, Ref. 24).

Diosmin ameliorates intestinal injury induced by hepatic ischemia reperfusion in rats.

BACKGROUND: Hepatic ischemia-reperfusion causes histologic injury to the intestinal mucosa. We investigated the effects of diosmin, a phelobotrophic drug with antioxidant and antiinflammatory effects, on intestinal injury in the experimental liver ischemia-reperfusion model. MATERIALS AND METHODS: Fourty rats were divided into four groups: sham group (Group 1), control group (Group 2), perop diosmin group (50 mg/kg) treatment group (Group 3) and preop 10-day diosmin (50 mg/kg) treatment group (Group 4). Ischemia-reperfusion model was carried out by clamping the hepatic pedicle for 60 min and then reperfusing the liver for 90 min. At the end of procedures, blood and ileum tissue samples were obtained for biochemical and histopathological assessments. RESULTS: According to the results of liver function tests (AST, ALT and LDH) there was a significant difference between the control and other groups (p < 0.001 for all). According to the plasma and ileum oxidative stress parameters (MDA, GSH-Px and XO), there was a significant difference between the control and other groups (p < 0.05 for all). Histopathologically; the specimens in Group 2 showed specific morphological abnormalities (the epithelial lining of the apical surface of villi was degenerated and desquamated to the lumen). Group 3 and 4 showed ileal histomorphology similar to the sham group. Pathological scores were significantly different between Group 2 and other groups. CONCLUSIONS: Diosmin can be administered for protection from destructive effects of hepatic ischemia-reperfusion injury on intestine in both emergent and elective hepatic surgical operations in which the possible ischemic periods are expected (Tab. 4, Fig. 1, Ref. 39).

Effect of propolis on oxidative stress and histomorphology of liver tissue in experimental obstructive jaundice.

BACKGROUND: Propolis is a natural product collected by honey bees from various plant sources. We aimed to determine the possible effects of propolis on oxidative stress and hepatocyte apoptosis in experimental obstructive jaundice. METHODS: Thirty rats were divided into three groups: group I, sham-operated; group II, ligation and division of the common bile duct (BDL); group III, BDL followed by oral supplementation of propolis in a daily dose of 100 mg/kg. Liver samples were examined under the light microscope and transmission electron microscope. Hepatocyte apoptosis was quantitated using the transferase-mediated uridine nick end labeling (TUNEL) assay. Plasma and liver malondialdehyde (MDA) levels and glutathione peroxidase (GSH-Px) activities were measured. RESULTS: The plasma and liver levels of MDA were significantly lower in the propolis group than in the BDL group (p < 0.05 and 0.014, respectively). Although liver GSH-Px activities were significantly higher in the propolis group than in the BDL group (p < 0.001), there was no significant difference between the plasma GSH-Px activities of these groups (p > 0.05). In the propolis group, the enlargement of hepatocytes, dilatation of canaliculi and the edema regressed. The regenerating and normal hepatocytes were demonstrated. In the TUNEL assay, propolis administration reduced hepatocyte apoptosis. CONCLUSION: Propolis showed a significant hepatoprotective effect in this experimental obstructive jaundice model.

Does povidone-iodine liposome hydrogel influence postoperative intra-abdominal adhesions?

PURPOSE: To evaluate the effect of PVP-I liposome hydrogel on intraperitoneal postoperative adhesions. MATERIAL AND METHODS: Thirty Wistar -Albino male rats were randomly divided into three groups. After midline laparotomy, a 1 cm(2) area of the caecum was abraded with a sterile gauze until subserosal haemorrhage had developed. A 1 x 1 cm patch of peritoneum located opposite of caecal abrasion was completely dissected. In group 1 (control group, C) adhesion induction was performed and nothing was applied to the wounds. In group 2 and 3, PVP-I solution (3%) (group 2, PI) and PVP-I liposome hydrogel (group 3, PIL) were applied to the caecal abrasion areas and peritoneal defects. Adhesions were classified according to a classification system based on the evaluation of the appearance, extent and strength of the adhesions on postoperative 2lst day. RESULTS: There was no significant difference of the adhesion scores between the groups (U1 = 45, p > 0.05 ; U2 = 48, p > 0.05 ; U3 = 47.5, p > 0.05). CONCLUSIONS: We found that PVP liposome hydrogel did not influence postoperative intraabdominal adhesions and should be further explored for its potential use in various intraabdominal procedures.

Effect of povidone-iodine liposome hydrogel on colonic anastomosis.

BACKGROUND: To evaluate the effect of povidone-iodine liposome hydrogel on colonic anastomosis. METHODS: 70 Wistar-Albino male rats were randomly divided into seven groups. The left colon was transected and end-to-end anastomosis was performed. PVP-I liposome hydrogel was applied around the anastomoses in groups 2 and 5. Colonic bursting pressures and tissue hydroxyproline contents were measured on postoperative days 3 and 7. RESULTS: PVP-I application did not cause any difference in the bursting pressures on postoperative day 3, but anastomotic strength was significantly increased by the use of PVP-I on postoperative day 7. The use of PVP-I liposome hydrogel had no effect on the level of perianastomotic hydroxyproline on postoperative day 3 but had positive effects on postoperativeday 7. CONCLUSIONS: We concluded that the beneficial effects of PVP-I liposome hydrogel might be due to the combination of broad-spectrum antimicrobial activity of PVP-I with the drug delivery properties and moisturizing molecular film effects of the liposome hydrogel.

Case report: duodenal stromal tumor.

Tumors of the small intestine are rare lesions, but they should be kept in mind as possible causes of gastrointestinal symptoms. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. A 78 year-old woman complaining of abdominal pain, nausea and vomiting after meal and weight loss for three months was admitted to our clinic. On physical examination, there was only epigastric tenderness. No mass was palpated. She was anemic and total protein and albumin levels were low. Other laboratory tests were normal. A 9.0 x 7.5 cm heterogeneous mass was detected on the abdominal computerized tomography scan. Endoscopy confirmed a polypoid and vegetative mass in the second part of the duodenum. Histopathological diagnosis of endoscopic biopsy was gastrointestinal stromal tumor. Pancreaticoduodenectomy was performed. On the 11th postoperative day, relaparotomy was performed due to biliary leakage from the subhepatic drain. Biliary leakage was from the choledochojejunostomy. Choledochojejunostomy and pancreaticojejunostomy were revised. She was discharged on the postoperative 25th day. Histopathological examination of the resection specimen revealed duodenal stromal tumor. Although stromal tumors are relatively rare in the duodenum, in the case of upper gastrointestinal obstruction and anemia, this type of tumors should be considered in differential diagnosis.

The effects of melatonin and prostaglandin E1 analogue on experimental hepatic ischaemia reperfusion damage.

The effects of antioxidant melatonin and a prostaglandin E1 analogue (PGE1) on hepatic ischaemia reperfusion damage were investigated. Fifty rats were divided into five equal groups: sham, control, melatonin, PGE1 and combined treatment. No procedures were applied to the sham group. In the control and treatment groups, the hepatic hilus was clamped at the level of the hepatic artery and portal vein for 60 min and reperfusion was provided for two hours. In the treatment and combined treatment groups, melatonin was administered intramuscularly at a dose of 20 mg/kg 15 mins before reperfusion, and PGE1 was administered intravenously at a dose of 25 mg/kg 1 min before reperfusion. Blood samples for SGOT, SGPT, GSH-Px, SOD and MDA measurements and hepatic tissue samples were taken. The decrease in the plasma MDA levels was statistically significant in the melatonin and combined treatment groups, but not in the PGE1 group (p > 0.025). A significant decrease was found in the tissue MDA levels of the treatment groups (p < 0.025). The decrease in SGOT and SGPT levels in the PGE1 group was significant (p < 0.025), but the decreases in the melatonin and combined treatment groups were not significant (p>0.025). Melatonin and PGE1 were found to be effective in reducing the hepatic ischaemia reperfusion damage in rats. However, the damage could not be reversed. Combined treatment was found not to be superior to melatonin or PGE1 alone.

Nonspecific ulcerated jejunitis as an unusual complication of laparoscopic cholecystectomy: report of a case.

We describe herein the case of a 65-year-old man in whom a lower gastrointestinal hemorrhage developed a few days after he underwent an elective laparoscopic cholecystectomy. A laparotomy was performed on postoperative day 16 and a jejunal segment containing mucosal changes and oozing ulcers was resected. Pathologic examination of the specimen revealed "nonspecific ulcerated jejunitis." There is no explanation for the etiopathogenesis of this pathology; however, we concluded that this clinical picture may be attributed to ischemia-reperfusion injury that occurred following an ischemic period caused by the pneumoperitoneum during laparoscopic surgery.

Effect of levamisole on intestinal anastomoses in transfused guinea pigs.

In this experimental study, the effects of an antihelminthic and immunostimulating agent (levamisole) on anastomosis recovery in transfused and normal guinea pigs were investigated. A total of 56 animals were divided into four groups of 14 each; an additional 10 were employed for blood transfusion (BT). Intestinal anastomoses were performed on all animals; the following postoperative treatments were administered: none (control group); BT; intra-abdominal (IA) levamisole; and BT + levamisole. After recording the mortality of each group, a relaparotomy was performed on one-half of the animals on the 3rd postoperative day and on the remaining half on the 7th postoperative day. Findings of IA sepsis, resistance of the anastomosis, bursting pressure, and hydroxyproline values were evaluated. Statistical comparison of the groups was accomplished by analysis of variance. In the transfused group an increase in sepsis was determined and the bursting pressure was significantly lower than in the control group. IA levamisole application following BT reduced the mortality by diminishing IA sepsis and anastomotic abscess formation and increased anastomotic pressure and recovery (P < 0.01). Histopathologic recovery in levamisole groups was better than in the group that received BT only. Levamisole application without BT resulted in equal mortality and morbidity to that of the control group. We conclude that clinical use of levamisole should be considered only in intestinal anastomoses in which BT is inevitable.

Sigmoid colon perforation due to geophagia.

Geophagia can be a problem in mentally handicapped patients. This case report presents a 71-year-old mentally handicapped women who had to be operated in emergency for colonic perforation due to geophagia.

Effects of L-thyroxine and zinc therapy on wound healing in hypothyroid rats.

Unfavourable effects of hypothyroidism and zinc deficiency on wound healing are well known. This experimental study was conducted on rats to evaluate the effects of hormone replacement and zinc supplement on wound healing. A total of 50 rats were divided into 5 groups of 10 rats as follows: Control group (A), a hypothyroidism group (B), a L-thyroxine receiving hypothyroidism group (C), a zinc receiving hypothyroidism group (D), and a L-thyroxine plus zinc receiving hypothyroidism group (E). In order to develop hypothyroidism, 5-propyl 2-thiouracil had been given intraperitoneally for a period of 21 days to all groups except the control group. A laparotomy with a 4 cm median incision was performed in all rats. The first half of the rats was sacrificed on the 7th day and the remaining on the 14th day. Breaking strength, hydroxyproline concentrations in the healing scar tissue and blood serum zinc levels were measured. Although both values--breaking strength and hydroxyproline levels--, compared to all others, were found to be higher in the L-thyroxine plus zinc receiving group (group E) on the 7th day, differences among the groups were not statistically significant. However, on the 14th day, these differences were found to be significant. We conclude that the hormone replacement therapy in hypothyroidism cases was beneficial with regard to wound healing and the results were more satisfactory if zinc was added to the therapy.

Fascioperitoneal graft with T-tube drainage for patching bile duct defects.

Reconstruction of choledochal wall defects in an experimental dog model by T-tube plus fascioperitoneal graft and an evaluation of the short-term results were the aims of this study. Twelve randomly selected mongrel dogs of both sexes, having an average weight of 22.15 +/- 1.85 kg, were anaesthetized with ketamine HCI and xylazine and underwent laparatomy. The front wall of choledoch canal were excised with its all layers 0.5 cm in diameter at the distal part of the cystic duct junctions. These defects were repaired by using grafts prepared of the same diameter from the dorsal fascias of rectus muscles and peritoneum. T-tubes were introduced into the common ducts on the proximal part of the grafts. One of the animals died in the postoperative period due to evantration. T-tube cholangiograms on the twelfth day did not indicate any extravasation or stricture. Histopathological examination of the graft regions on the sixtieth day revealed that the epithelialization had commenced on the border between the bile epithelium and grafts. Based on these early findings, it was suggested that if supported by further studies it may be thought of as a clinical method.