Effects of Copper, Zinc, and Vitamin Complex (Cernevit®) on Hepatic Healing in Rats Experimentally Subjected to Blunt Hepatic Trauma.

Solid organ injuries following blunt trauma are frequently encountered. The use of non-operative approach is gradually increasing. Thus, research on the methods that could enhance healing in solid organ injuries is in progress. Agents known to have antioxidant property were used after an experimentally induced blunt hepatic trauma. Thirty-two Wistar albino rats weighing 200 g were dropped from a height of 40 cm on to the right upper abdominal quadrant to produce a grade II-III hepatic injury. Rats were divided into control, Zn-administered, Cu-administered, and vitamin complex-administered groups, with eight rats in each. Aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were measured in the blood samples. The percentage of cells displaying Ki-67 nuclear staining was estimated. The sections were stained with hematoxylin and eosin and the degree of inflammation in the samples was semi-quantitatively assessed. Treatment with zinc, copper, and Cernevit® caused varying levels of decrease in AST, ALT, and LDH levels compared to the control group. Ki-67 positivity was significantly lower in group I compared with groups II and III (p = 0.002). Ki-67 positivity was significantly higher in group II compared to the other groups (p < 0.05). A marked improvement was observed in inflammation in group II. Copper and zinc treatment decreased inflammation as well as blood levels of AST and ALT, and enhanced the healing of traumatized hepatic tissue. However, Cernevit® reduced only the degree of inflammation.

The efficiency of various doses of topical isosorbide dinitrate in the treatment of chronic anal fissure and the long-term results: a prospective, randomized and controlled clinical trial.

BACKGROUND/AIMS: In recent years, numerous studies have reported that the application of topical isosorbide dinitrate can cause fissure recovery with the relaxation of the internal anal sphincter. However, there is no consensus about the dose or duration of the drugs to be applied. In addition, long-term results of the patients with chronic anal fissure treated with nitrate-containing compounds are unknown. In this study, the goal was to investigate the effects of various doses of isosorbide dinitrate on chronic anal fissure and their long-term effects. METHODS: Seventy-five sequential patients with chronic anal fissure were divided into three groups. Only symptomatic treatments were applied to patients in the first group (n=15). The patients in second and third groups (n=30 each) were treated with topical isosorbide dinitrate 5% and 10%, respectively. The patients were examined three times at 20-day intervals. Five years later, 44 patients who were responsive to treatment were contacted by telephone. RESULTS: The rate of full response in the 10% isosorbide dinitrate group was statistically higher than of the 5% isosorbide dinitrate group on the 20th day (53.3% vs. 26.7%, p<0.05). However, the rate of full response did not differ between these groups on the 40th and 60th days (63.3% and 70% vs. 56.7% and 63.3%, p>0.05). Five years later, 52.3% of patients who were responsive to treatment had a symptomatic relapse. CONCLUSIONS: Topical isosorbide dinitrate is a good alternative therapy to protect internal anal sphincter in the treatment of chronic anal fissure. However, the recurrence rates are high in the long-term.

Pneumatosis cystoides intestinalis: a single center experience.

AIM: To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI). METHODS: The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. RESULTS: Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d. CONCLUSION: Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

The effect of antivascular endothelial growth factor on the development of adhesion formation in laparotomized rats: experimental study.

Aims. This study determined the effects of a single dose of bevacizumab, an antiangiogenic recombinant monoclonal antibody that specifically targets vascular endothelial growth factor (VEGF), on adhesion formation in the rat cecal abrasion model. Methodology. Thirty female Wistar albino rats (200-224 g) were divided into three groups. All rats underwent laparotomy at which time cecal wall abrasion and abdominal wall injuries were induced. Group I (control) underwent only the abrasion procedure; Groups II and III received saline or bevacizumab intraperitoneally, respectively, following the abrasion. The rats were killed on postoperative day 7, and the severity of adhesions was evaluated, together with histopathological fibrosis parameters and immunohistochemical staining to identify the VEGF receptor. Results. The mean adhesion severity score in Groups I-III was 2.5 ± 0.52, 2.4 ± 0.69, and 0.7 ± 0.82, respectively; the score in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). In the histopathological evaluation, the mean fibrosis score in Group III was significantly lower that the scores in Groups I (P < 0.001) and II (P < 0.001). VEGF staining of the adhesion areas in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). Conclusion. Bevacizumab decreases adhesion formation following laparotomy in rats by blocking VEGF receptor occupancy.

Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease.

PURPOSE: Recurrence after surgery for pilonidal disease remains a challenge. We investigated the application of crystallized phenol as a nonoperative treatment for patients with recurrent, previously operated pilonidal disease. METHODS: Participants were patients treated for recurrent pilonidal disease at our clinics from January 1995 through August 2007. Crystallized phenol was administered on an outpatient basis. Patient and disease characteristics including age, gender, body mass index, occupation, family history, time from previous operation to recurrence and to phenol treatment, number and type of previous operations, and characteristics of recurrent sinuses at entry were prospectively recorded. Outcome variables included number of phenol applications, recovery time, recurrence, and treatment success or failure. RESULTS: A total of 36 patients with recurrent pilonidal disease were treated with crystallized phenol (mean recurrence time after previous surgery, 16.2 +/- 4.6 months; number of previous operations, 1.47 +/- 0.9). The mean number of phenol applications per patient was 3.7 +/- 1.3 (range, 1-7). No serious side effects were observed. Exfoliation of a 2-cm area around the sinus openings in 3 patients (8.3%) was easily treated with ointments locally; patients reported minimal pain. Healing was obtained in all patients in a median of 48 (range, 10-153) days. During follow-up (mean duration, 54.4 +/- 5.2 months; range, 29-169 months), 31 patients (86.1%) had no recurrence and 5 patients (13.9%) had recurrence. Recurrent sinuses were successfully treated by a second course of crystallized phenol in 2 patients, 1 patient refused retreatment, and healing was not obtained with a second treatment course in 2 patients, yielding an overall success rate of 91.7% and failure rate of 8.3%. CONCLUSION: Crystallized phenol application is a simple, inexpensive nonoperative procedure that can be performed in an outpatient setting and is suitable for the treatment of previously operated recurrent pilonidal disease.

The application of SpyScope® technology in evaluation of pre and post liver transplant biliary problems.

BACKGROUND/AIMS: Peroral cholangioscopy with its limitations led to further research regarding development of SpyScope® technology. The aim of this retrospective study was to investigate the efficacy of a new device and the application of this device in our Liver Transplant Center. METHODS: Charts of patients who had undergone evaluation with SpyScope® were retrospectively reviewed. Indications included pre-transplant as well as post-transplant evaluation of biliary strictures. If strictures or filling defects were noted by cholangiogram, SpyScope® was performed. Biopsy was obtained under direct visualization if necessary with SpyBite® biopsy forceps. Demographic features, indications for SpyScope® evaluation, results, and histopathological diagnoses were recorded. RESULTS: Ten patients (6 male, 4 female; median age: 55) had undergone SpyScope® procedure between August 2007 and January 2008. Six out of 10 cases were in the pre-transplant work-up period, referred to as Group I, while the remaining four were post-transplant patients, referred to as Group II. In Group I, 4 of 6 cases had undergone the procedure for work-up of primary sclerosing cholangitis prior to orthotopic liver transplantation. In Group II, indications were either strictures noted during the previous endoscopic retrograde cholangiopancreatography (n=2) or common bile duct stones with elevated total bilirubin levels and stones with long segment biliary stricture (n=2). In the patient with anastomotic stricture, the biliary lithiasis was eventually exposed just above the anastomotic stricture, after abundant lavage was applied at that level. All SpyBite® biopsy specimens were reported to be adequate samples for histopathological examination. No malignancy was detected among 4 patients with primary sclerosing cholangitis and patients with elevated CA 19-9. CONCLUSIONS: SpyScope® allows direct visualization of biliary strictures and SpyScope®/SpyBite® were found to be technically superior to conventional cholangiogram with better sampling than brushing obtained by endoscopic retrograde cholangiopancreatography. Prospective, multicenter, large volume studies are warranted to identify its sensitivity and specificity.

Nutritional effects of transjugular intrahepatic portosystemic shunt--an often neglected benefit? "A preliminary report".

Transjugular intrahepatic portosystemic shunt (TIPS) is a useful procedure for preventing complications of portal hypertension. Nutritional effects of TIPS have been described in cirrhotics. In this prospective study, the nutritional effects of TIPS in cirrhotics were aimed to be identified. BMI, anthropometric measurements, laboratory parameters and Chronic liverdisease quality of life score were measured at baseline, three and six moths following TIPS placement. Total of 12 patients (6 male, 6 female; mean age 56 years; range 41-80) were enrolled between March 2002 and June 2004. Mean baseline MELD score was 13. Only 6 out of 12 patients were able to complete the study due to several reasons. BMI increased from 21.4 to 25.5. Estimated muscle mass improved from 16.6 to 20.5 (p < 0.05). Mean serum albumin improved from 2.46 to 2.76. CLDQL score improved from 103 to 150 (p < 0.05). This small study suggests potential nutritional benefits of TIPS.

Avoiding pitfalls: what an endoscopist should know in liver transplantation--part II.

Over the last decade the number of patients undergoing transplantation has increased. At the same time, effective peri- and postoperative care and better surgical techniques have resulted in greater numbers of recipients achieving long-term survival. Identification and effective management in the form of adequate treatment is essential, since any delay in diagnosis or treatment may result in graft loss or serious threat to patient's life. Various aspects of endoscopic findings that can be commonly encountered among liver transplant recipients are discussed herein. Topics include: persistent and/or recurrent esophageal varices, reflux, Candida or cytomegalovirus (CMV) esophagitis, esophageal neoplasms, posttransplant peptic ulcer, biliary complications, posttransplant lymphoproliferative disorder (PTLD), Kaposi's sarcoma, CMV colitis and inflammatory bowel disease, colonic neoplasms, Clostridium difficile infection, and graft versus host disease (GVHD).

Management of hepatic metastasis from colorectal cancers: an update.

Approximately 50%-60% of patients with colorectal cancers will develop liver lesions in their life span. Despite the potential of surgical resection to provide long-term survival in this subset of patients, only 15%-20% are found to be resectable. The introduction of new neoadjuvant chemotherapeutic agents and the expanding criteria of resection have enhanced the overall 5-year survival from 30% to 60% in the past decade. The use of technical innovations such as staged resection; portal vein embolization, and repeat resection have allowed higher resection rates in patients with bilobar disease. Extrahepatic primary and liver-exclusive recurrent disease no longer represent an absolute contraindication to resection. The role of regional therapy using hepatic arterial infusion is being redefined for liver-exclusive unresectable disease. Adjuvant chemotherapy in combination with regional therapies is being looked at from fresh perspectives. Ablative approaches have gained a firm role both as an adjunct to surgical resection and in the management of patients who are not surgical candidates. Overall, the management of hepatic metastasis from colorectal cancers requires a multimodal approach.

Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study.

OBJECTIVE: Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD: Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS: In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS: In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.

Unusual presentation of recurrent hepatocellular carcinoma as obstructive jaundice 15 years after liver transplant.

Hepatocellular carcinoma recurrence is a known limitation of liver transplant. Recurrence rates have been reported in 10% to 60% of patients within an average of 1 to 2 years following liver transplant. We report a case of recurrent hepatocellular carcinoma 15 years after orthotopic liver transplant, presenting initially as obstructive bile duct compression as detected by cholangiogram. Laparotomy revealed hepatocellular carcinoma invading the common bile duct without any mass in the liver parenchyma. The main focus of the case is the endoscopic retrograde cholangiopancreatography image, which is unique in the setting of liver disease following liver transplant.

Compatible ABO mismatch and liver transplantation: a single center's experience.

OBJECTIVES: The current shortage of suitable donor organs and clinical urgency can lead to implanting grafts from ABO-mismatched donors. One-year graft survival rates for patients in this scenario have been reported as ranging between 25% and 75% less than those for ABO-identical or ABOcompatible grafts. We review and compare our experiences with transplanting ABO-identical and ABO-compatible mismatched livers. MATERIALS AND METHODS: Considering orthotopic liver transplantation (OLTx), 520 were performed at our institution between November 1992 and May 2003, 55 of which were ABO-compatible mismatched transplants. We retrospectively reviewed the data and compared patient and graft survival rates. RESULTS: Overall 1-month and 1-, 5-, and 10-year patient survival rates among identical (group 1) and mismatched (group 2) groups were 97% and 91%, 90%, and 88.5%, and 79%, and 74%, 66%, and 65%, respectively. No significant difference existed between the 2 groups (P>.05). Similarly, 1-month, and 1-, 5-, and 10-year graft survival rates among groups 1 and 2 were 96% and 87%, 89% and 83%, 78% and 71% and 66% and 59%, respectively; these were not significant either (P>.05). All of the patients in the mismatched group had a high status according to the United Network for Organ Sharing (UNOS). Only 1 person received an incompatible mismatched graft (B to A), which subsequently developed primary nonfunction. CONCLUSIONS: ABO-compatible mismatch OLTx is unavoidable given the current state of organ shortage. Our results suggest that this type of OLTx can be performed with minimal risk among patients who require urgent transplantation and have high rankings according to the UNOS and the model for end-stage liver disease (MELD) system.

Comparison of Kugel and Lichtenstein operations for inguinal hernia repair: results of a prospective randomized study.

INTRODUCTION: The aim of this prospective randomized clinical study was to compare the Lichtenstein hernia repair with Kugel's patch hernia repair. METHODS: From September 1999 to August 2002, adult patients with inguinal hernia were randomized into two groups. Group I included patients with the Lichtenstein hernioplasty, and group II included patients with the Kugel hernioplasty. The duration of the operation, surgical findings, and postoperative complications were recorded for the patients in both groups. RESULTS: A total of 139 patients (134 men, 5 women) were randomized to either group I or group II. No significant differences were observed for the duration of the operation or the complication rates between the groups during the same follow-up time (53.06 +/- 5.6 months vs. 53.41 +/- 7.11 months in groups I and II, respectively). CONCLUSIONS: Kugel herniorraphy is a minimally invasive method and as safe as the Lichtenstein hernia repair technique, with similar complication rates.

Inhibitory effects of sildenafil citrate on the tonus of isolated dog internal anal sphincter.

PURPOSE: Although the exact pathogenesis of anal fissure is not known, hypertonicity of the internal anal sphincter might be involved in its pathogenesis as main event. To gain information about possible usefulness of the novel, smooth-muscle-relaxing drug, sildenafil, in chronic anal fissure, we investigated the effect of sildenafil citrate on acetylcholine-induced contractility of internal anal sphincter isolated from dogs. METHODS: Internal anal sphincter strips were taken from German shepherd dogs and suspended in a tissue bath filled with Krebs solution at 37 degrees C (pH 7.4) continuously bubbled with 95 percent oxygen and 5 percent carbon dioxide, and isometric contractions were recorded. Contractions were evoked by 10 muM acetylcholine, and the effects of different concentrations of sildenafil citrate (0.1, 0.3, and 1 mM) on the isometric tension of each internal anal sphincter strip were examined. The statistical significance was analyzed by one-way analysis of variance. RESULTS: Pretreatment with sildenafil citrate (0.1 mM) attenuated contractile response to acetylcholine (n = 3), which were significantly weak compared with the maximum contractile response to the acetylcholine alone (610 +/- 110 mg vs. 2,825.17 +/- 416 mg; n = 12; P < 0.05). Sildenafil citrate also significantly inhibited the acetylcholine-induced contractions in a dose-dependent manner when applied after. CONCLUSIONS: This experimental in vitro study showed that sildenafil citrate relaxes acetylcholine stimulated contractions of isolated dog internal anal sphincter. This may be of importance for raising the possibility that sildenafil cit-rate may have future potential in the treatment of chronic anal fissure. Further studies are needed for a conclusive decision on possible usefulness of sildenafil citrate in patients with chronic anal fissure.

The possible contribution of 129I in the drinking water and food supply to the nodular formation of thyroid tissue.

Nodular formation of the thyroid tissue can occur as a result of exposure to radiation. The nodular goiter is a common disease seen in the city of Elazig and its surroundings, in the eastern part of Turkey. A prospective study was conducted in an effort to identify the role of 129I in drinking water supply. Specimens obtained from nodular and normal thyroid tissue during surgery and also water specimens were counted by nuclear spectrometric system. 129I radioactivity in nodular tissue was noted to be higher compared to normal tissue and the difference was statistically significant (p <0.05). There was no statistically significant difference (p >0.05) between 129I radioactivity in the water supply and tissue obtained from the patients who have malignant or benign nodular lesions. These results support that the 129I radioactivity level in the water supply is one of the risk factors of the nodular formation of the thyroid tissue in the eastern part of Turkey.

Predictive value of procalcitonin for the diagnosis of bowel strangulation.

Intestinal obstruction is responsible for 3% of admissions to hospital emergency surgical departments, but it is difficult to distinguish simple obstruction from strangulation. Simple criteria for this distinction are sought. In this experimental study, procalcitonin, a known marker of bacterial inflammation, was used to detect strangulation. The predictive value of procalcitonin for small bowel strangulation was evaluated. Thirty male New Zealand rabbits (mean weight: 3.0 kg) were divided into three groups. In the first (control) group, only laparatomy was performed. In the second group, simple obstruction was created by ligating a 10-cm distal ileum segment. In the third group, distal strangulation was created by ligating a 10-cm distal ileum segment with the mesentery. Blood (1 cc) was taken from the right auricular vein of each animal for measuring the procalcitonin level. In both the control group and the simple obstruction group the procalcitonin levels were normal. In the strangulation group, elevation of procalcitonin was detected after 30 minutes, and the elevation was statistically significant at 120th minute compared with the control and simple obstruction groups. In patients with small bowel obstruction, measurement of procalcitonin levels is easy to perform and can be used in the follow-up. A more extensive clinical study is needed to evaluate the accuracy of the test as a marker.

Pilonidal sinus treated with crystallized phenol: an eight-year experience.

PURPOSE: The aim of this study was to determine the impact of crystallized phenol on the outpatient treatment of pilonidal disease. PATIENTS AND METHODS: A retrospective analysis was undertaken of patients seen in the outpatient surgery clinic of the University Hospital, Elazlg, Turkey. Age, gender, body mass index, characteristics of sinuses at initial presentation, and the recovery time of 41 patients were analyzed. The relationship between recovery time and the number of sinus openings, presence of abscess, and status of the sinuses (acute vs. chronic) were noted. RESULTS: Crystallized phenol was applied a total of 107 times on 41 patients. Seventy percent of the patients had two to three applications. Mean recovery time was 42.7 (+/- standard deviation of 24) days with a range of 13 to 120 days. Recurrences were observed in only two patients at the fifth and eighth months following recovery. The success rate was 95.1 percent. Median follow-up was 24 (range, 6-98) months. The status of sinuses (acute vs. chronic and presence or absence of abscess) and the number of sinus opening had no effect on recovery time (P > 0.005). CONCLUSION: Crystallized phenol treatment is a simple and inexpensive method that can be readily applied on an outpatient basis, decreasing both the recurrence rate and lost work time. We suggest that this method be considered the first-line treatment of any type of pilonidal sinus.

[Skin defect coverage with micro skin graft]. / Mikro deri grefti ile defekt onarimi.

BACKGROUND: The aim of this study is to coverage of the large skin defect with microskin graft. METHODS: The wound coverage of the large skin defect may be difficult with auto skin graft. In these patients, split thickness skin graft may be used in a bloc shape or expanded skin graft shape and a stamp skin graft shape or expanded stamp skin graft shape. On the other hand, split thickness skin graft may be used as a micrograft shape after the mincing process, which reduces of the graft size in a few millimeters. In this study, 6 patients with skin defect was admitted in our clinic, and their skin defect was treated with micro skin graft. Expansion ratio was 1:15. RESULTS: Epithelialization on the wound surface was completed in 4 to 6 weeks and cobblestone appearance was observed after the wound coverage. CONCLUSION: Skin defect coverage with micrograft is an effective technique like the other skin graft coverage methods.