Effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats.

OBJECTIVE: It has been proven that malnutrition increases postoperative morbidity and mortality, and it may also negatively affect wound healing in the gastrointestinal tract. In the literature, there is only one study evaluating the effects of preoperative nutritional support on colonic anastomotic healing under malnourished conditions. In order to improve the data on this topic, an experimental study was planned to evaluate the effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats. MATERIAL AND METHODS: The study included 18 male Wistar albino rats divided into 3 groups. The control (C) group was fed ad libitum for 21 days. The malnutrition (M) group and preoperative nutrition (P) group were given 50% of the daily food consumed by the rats in Group C for 21 days to induce malnutrition. At the end of 21 days, Group P was fed ad libitum for 7 days (preoperative nutritional support). Colonic transection and end-to-end anastomosis was performed at 21 days in Group C and Group M and at 28 days in Group P. The rats were sacrificed at postoperative 4 days, anastomotic bursting pressure was measured, and samples were taken to analyze tissue hydroxyproline levels. RESULTS: Anastomotic bursting pressure was significantly higher in Group C than in Group M and Group P (p<0.05), and it was significantly higher in Group P than in Group M (p<0.05). Tissue hydroxyproline levels in Group P were found to be significantly higher than those in Group M and Group C (p<0.05). CONCLUSION: One week of preoperative nutritional support increases collagen synthesis in the colon and positively affects anastomotic healing under malnourished conditions.

The effect of honey on the intestinal anastomotic wound healing in rats with obstructive jaundice.

BACKGROUND: Jaundice has been associated with an increased incidence of postoperative hernias, decreased wound and anastomotic bursting pressure, and reduced tissue collagen synthesis. This study is aimed to examine the possible effects of honey supplementation on anastomotic wound healing in obstructive jaundice (OJ) model. METHODS: Eighty wistar-albino rats were divided into four groups as control, OJ, O plus artificial honey and OJ plus honey. Rats were fed with standard rat chow (SRC) in group-I&II, SRC plus 10 mg/kg/day honey in group-4 and SRC plus artificial honey including the same caloric amount with honey in group-3. Colon anastomoses were performed in all groups. Also, common bile duct ligation was performed in group-1, group-2 and group-3. On the postoperative 3rd and 7th days, anastomotic healing was evaluated. RESULTS: The hydroxyproline level was significantly lower in the jaundiced animals compared with the controls and those given honey or artificial honey (p<0.05). The anastomotic bursting pressure results showed a correlation with the hydroxyproline results, and the use of honey significantly increased the bursting pressure compared with that of the bile duct ligated group (p<0.05). CONCLUSION: The oral administration of honey can be considered when attempts at conventional internal drainage fail in obstructive jaundice (Tab. 2, Fig. 6, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

A single-surgeon, single-institute experience of 59 sinotomies for sacrococcygeal pilonidal disease under local anesthesia.

BACKGROUND: The sacrococcygeal pilonidal disease affects relatively young people, causing much nuisance and many lost working days. The ideal treatment should be simple, allowing a speedy recovery with short hospitalization while affording a permanent cure. Currently, many treatment options are available; unfortunately, none of them is ideal and each has its own recurrence rate. In this study, we wanted to emphasize the effectiveness of sinotomy in sacrococcygeal pilonidal sinus disease by single-surgeon's experience. METHODS: Single-surgeon's experience of 59 pilonidal sinus patients was reviewed at single-institute between July 2005 and December 2006. 2% Prilocaine was injected for local anesthesia and sinotomy technique was performed. All patients were discharged at postoperative second hour and were followed up for a minimum 1 year. RESULTS: Median age of the 59 patients was 24 (14-56) years. Forty-six (77.96%) of them were male and 13 (22.03%) of them were female. Healing completed in 1 month and almost all the patients were able to return to work the following day. We proudly have no recurrence at our mean follow up time of 16 months (range: 12-24 months). Our complication rate was 1.69%. CONCLUSION: Sinotomy has the advantages of simplicity, the possibility to operate under local anesthesia with excellent recurrence rate of 0% (Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Gastric adenocarcinoma and GIST (collision tumors) of the stomach presenting with perforation; first report.

Gastrointestinal stromal tumors are very rare tumors of stomach. To our knowledge there are a few reported cases of synchronous occurrence of epithelial and gastrointestinal stromal tumors of stomach. Also, tumor perforation is very rare. This is the first case of gastrointestinal stromal tumor synchronous with primary gastric adenocarcinoma presented with perforation (Fig. 1, Ref. 6).

Giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, type-2 diabetes mellitus and hypertension.

Liposarcomas represent the single most common type of soft tissue sarcoma, occurring most commonly in the extremities and retroperitoneum. There is no relation between liposarcomas and multiple endocrine syndromes. We presented a 61-year old woman with giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, Type-2 diabetes mellitus (T2DM) and hypertension. The mesenteric liposarcoma was reported neither synchronously bilateral nor with endocrine disorders. We must note if the patients' presentation was a co-incidence or an undescribed syndrome, waiting to be discovered.

Axial torsion and gangrene of a giant Meckel's diverticulum mimicking acute appendicitis.

Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract, occurring in 2% of the population. More than 80% of patients are asymptomatic. Complications like intestinal obstruction, bleeding and inflammation of Meckel's diverticulum occur in 4% of patients. The case of a 42-year-old male patient with axial torsion and gangrene of giant Meckel's diverticulum is presented.

A single-surgeon, single-institute experience of 115 Lichtenstein hernia repairs under local anesthesia.

BACKGROUND: Repair of an inguinal hernia is one of the most common operations performed in general surgery with significant costs to health care and society. Lichtenstein mesh repair has been the most widely performed groin hernia repair. In this study, we wanted to emphasize the effectiveness of local anesthesia in groin hernia repair by single-surgeon's experience. METHODS: One-hundred and fifteen inguinal hernia patients were reviewed between July 2005 and July 2007. 2% Prilocaine was injected for local anesthesia and Lichtenstein polypropylene mesh repair technique was performed. Pain was assessed after operation by using a visual analogue scale (VAS). All patients were controlled at postoperative first week, first month and end of first year. RESULTS: 113 (98.26%) of 115 patients were discharged at postoperative 8th hour. The other 2 patients (1.739%) were discharged at postoperative second day. They were followed up two days, because of seroma and pain, individually. Mean VAS score was 3.2 (2.7-4.0 95% CI). There was no statistically significant difference between groups, according to Nyhus classification, right/left inguinal hernia and gender. CONCLUSION: Lichtenstein mesh repair under local anesthesia is an effective day case technique, particularly in the elderly and medically unfit patients. The economic benefits are enhanced by low morbidity and low recurrence rates (Ref. 5). Full Text (Free, PDF) www.bmj.sk.

The PlasmaKinetic tissue management system in thyroid surgery.

BACKGROUND: Thyroid surgery involves meticulous devascularization of the gland. Although conventional technique being a highly efficient technique for vessel bleeding control, it takes long time. The aim of this study was evaluate the efficacy of PlasmaKinetic to the conventional technique. METHODS: We reviewed the medical records of 86 patients who underwent primary thyroid surgery by the same surgeon at our clinic between June 2006 and January 2008. Total thyroidectomy was performed at all of the patients in the study group. RESULTS: When the incidence of postoperative cord palsy was 2.32%, transient hypoparathyroidism was 4.6%. There was no significant difference in consideration of age, gender, thyroid gland weight, and complication rates between the PlasmaKinetic group and conventional group (p>0.05). Operation time, mean drainage from the suction drain and duration of hospital stay of the patients in PlasmaKinetic group were significantly lower than those in conventional group (p<0.05). CONCLUSION: PlasmaKinetic technique decreases the operation time to a level of less than 50 minutes with no increase at complication rate (Tab. 3, Fig. 3, Ref. 14). Full Text (Free, PDF) www.bmj.sk.

Amebic perforation of small bowel: an unexpected localization of a fatal complication.

The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebiasis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

Results of lateral internal sphincterotomy with open technique for chronic anal fissure: evaluation of complications, symptom relief, and incontinence with long-term follow-up.

The aim of this study is to investigate the results of open lateral internal sphincterotomy (LIS) and the recurrence and incontinence rate, to perform a long-term assessment of incontinence and to assess complications and relief of symptoms. This clinical prospective study was undertaken in patients undergoing open LIS. One hundred and twenty-nine patients entered the study. Mean duration of pain relief was 1.2 +/- 0.4 days and mean time before defecation without pain was 1.9 +/- 1.0 days. Complication rate was 41.8%. We found that urine retention was seen frequently in males. We demonstrated that open LIS up to the dentate line does not have a higher rate of incontinence. Incontinence after LIS was only to flatus and two-thirds of these resolved in 6 weeks. No patient showed improvement of incontinence after 6 weeks.

Emergency spontaneous gastric perforations: ulcus versus cancer.

BACKGROUND: The spontaneous perforation of gastric cancer is a rare fatal complication, occurring in 1% of patients with gastric cancer, and it has a wide hospital mortality range (0-82%). In addition, it has been reported that about 10-16% of all gastric perforations are caused by gastric carcinoma. The aim of this study is to evaluate the gastric perforations and improve an alternative pathway for the management of this disorder when a pathologist is not available. MATERIAL AND METHODS: We reviewed the medical records of 513 patients who had undergone surgical treatment for gastric perforation due to gastric ulcus or gastric carcinoma in two medical centers. Sixty-seven (13.06%) patients were treated for perforated gastric carcinoma. Perforations due to trauma and iatrogenic causes were excluded. The clinicopathologic features of all patients were analyzed on the basis of their medical records. RESULTS: According to the results of our analysis, we can suggest that if a patient with gastric perforation has an age more than 60 years, an ulcus diameter (with edema) more than 6 cm, a perforation diameter more than 0.5 cm, a symptom duration of more than 20 h, and a white blood cell count less than 15.10(3)/microL, he might have a gastric carcinoma. This system has a specificity of 98.7%, a sensitivity of 53.7%, a negative predicted value of 93.4%, and positive predicted value of 85.7%. CONCLUSION: The diagnosis of malignancy is often made only on postoperative or operative frozen pathologic examination. We suggest a new pathway for the gastric perforations, if a pathologist is not available during the operation.

Does low molecular weight heparin impair anastomotic wound healing?

BACKGROUND: Enoxaparin is an important molecule which had been using in prophylaxis and treatment of deep venous thrombosis. Also, it is showed that it prevents postsurgical peritoneal adhesions in rats. It is aimed to evaluate its effects on gastrointestinal wound healing. METHODS: Thirty Wistar albino rats were divided into three groups as control, subcutan, and intraperitoneal enoxaparin groups. Left colon anastomoses were performed. On postoperative seventh day, anastomotic healing was evaluated by measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological examination. RESULTS: The anastomotic bursting pressure was highest in subcutan enoxaparin group (p < 0.001), intraperitoneal enoxaparin group (p < 0.01) came the second, and the control group has the worst value. The hydroxyproline results were found nearly similar to the bursting pressure values (subcutan (p < 0.001) > intraperitoneal (p < 0.05) > control). Neovascularization in subcutan group (p < 0.001) has a statistically significant difference to other groups. CONCLUSION: Enoxaparin did not interfere with colonic anastomotic resistance but improved the intestinal wound healing.

Family history of acute appendicitis.

OBJECTIVES: To evaluate the association of acute appendicitis with age, sex, Alvarado score (AS) and family history. METHODS: Medical records of 2670 patients, who were admitted to our hospital's emergency department between January 2005 and June 2007, were reviewed. These patients were referred as acute abdominal pain by general practitioners. The data of patients were devided into sub-groups according to their age, sex, operative status, AS status and having a pathologically confirmed postoperative diagnose of acute appendicitis or not. Logistic regression analysis was performed to find out relationships among the sub-groups. RESULTS: Male gender (1.37), age < 50 (2.4), positive family history (3.16), AS 5-6 (13) and AS 7 (31) increased the risk of acute appendicitis. The sensitivity and specificity of AS was 91.5% and 60.5% respectively. The sensitivity and specificity of family history was 68.9% and 75.4% respectively. CONCLUSION: Family history is an important parameter while predicting acute appendicitis.

Perforation of gallbladder.

OBJECTIVE: Gallbladder perforation is a rare but life threatening complication of acute cholecystitis. Aim of this study is to present our clinical experience with gallbladder perforation. MATERIAL AND METHODS: Thirty-seven of retrospectively reviewed 1042 acute cholecystitis patients were found to have gallbladder (GB) perforation. Perforations due to trauma, iatrogenic causes, and gallbladder carcinoma were excluded. RESULTS: Abdominal ultrasound (US) showed gall stones in all of the patients with type-I and type-II gallbladder perforations (GBP), extensive intraperitoneal free fluid in 9 patients with type-I GBP, and a small amount of pericholecystic free fluid in 7 patients with type-II GBP. Abdominal US did not show GB wall defect in any of the patients, but showed intraperitoneal free gall stone in one type-I and one type-II GBP patients. CT revealed GB wall thickening in all of the patients, gall stones in 7 patients, extensive intraperitoneal free fluid in 7 patients, a small amount of pericholecystic free fluid in 8 patients, and GB perforation sites in 4 patients. Abdominal CT and US detected subhepatic abscesses in 3 patients. CONCLUSION: Early diagnosis of gallbladder perforation and immediate surgical intervention are of crucial importance. Unfortunately, the limited success of US and CT for detecting the GBP let us advocate early and urgent surgery (Tab. 3, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Bilateral Paget disease of the male nipple: first report.

Bilateral breast carcinoma is reported to occur in 5-10% of all patients with breast cancer. Paget disease of the breast represents 1-3% of all breast malignancies [Ashikari R, Park K, Huvos AG, Urban JA. Paget's disease of the breast. Cancer 1970;26:680-5; Marshall JK, Griffith KA, Haffty BG, Solin LJ, Vicini FA, McCormick B, et al. Conservative management of Paget disease of the breast with radiotherapy. Cancer 2003;97:2142-9]. However, synchronous bilateral Paget disease of the nipple is extremely rare. We report synchronous bilateral Paget disease with infiltrative ductal carcinoma in a 74-year-old man who underwent bilateral mastectomy.

Castleman's disease of the duodenum.

Castleman's disease is a rare lymphoproliferative disorder of uncertain origin. Just two cases of Castleman's disease of the gastrointestinal tract have been reported. These were found in the stomach. However, as far as we know, Castleman's disease of the duodenum has not been reported. This is the first report of hyaline vascular subtype of Castleman's disease at the duodenum.