The effects of the use of hyoscine-N-butylbromide during laparoscopic sleeve gastrectomy.

Objectives: Hyoscine-N-butylbromide is used by some surgeons during laparoscopic sleeve gastrectomy (LSG) to loosen gastric smooth muscles and to provide a more effective LSG. However, evidence-based data on the effects of hyoscine-N-butylbromide in laparoscopic sleeve gastrectomy are limited and its effect on sleeve gastrectomy surgery and weight loss is unknown. The aim of this study was to analyze the effect of intraoperatively administered hyoscine-N-butylbromide on stomach resection volume, weight loss and complications seen in patients undergoing LSG. Material and Methods: Patients who underwent laparoscopic sleeve gastrectomy due to morbid obesity were included in the study. Intraoperative hyoscine-N-butylbromide was administered to 52 patients (Group 1), not applied to the other 52 patients (Group 2). Age, sex, height, weight and body mass index (BMI) data of the patients were obtained retrospectively. The weight, BMI, percentage of total weight loss (TWL%) and percentage of excess weight loss (EWL%) of the patients were evaluated at postoperative third, sixth and 12th months. Results: Resected gastric volume (p= 0.111), length of stapler line (p= 0.944), operation time (p= 0.383), hospitalization time (p= 0.494) and postoperative complications (p> 0.05) did not differ between Groups 1 and 2. However, frequency of intraoperative tachycardia (p <0.001) and hypotension (p= 0.006) in Group 1 was significantly higher than in Group 2. TWL% and EWL% values were similar between the two groups at all-time points. Stapler line leakage was not observed in any patient during the postoperative period. Conclusion: Intraoperative hyoscine-N-butylbromide use is not effective on weight loss postoperatively in patients undergoing LSG. Although hypotension and tachycardia occured in some of patients, none of the patients had complaints in the early or long-term postoperative period. The use of hyoscine-N-butylbromide during LSG is safe but does not have any effect on weight loss.

Ingestion of Cylindrical Battery and Medical Treatment.

Due to their chemical properties, accidental or suicidal ingestion of batteries into the digestive system can cause fatal complications; Treatment should not be delayed and close monitoring is required. A 26-year-old male patient is treated by the psychiatry department with diagnoses of antisocial personality disorder and depressive adjustment disorder. He consulted with the complaint of ingesting cylindrical AA battery for suicidal purpose. In our case, the cylindrical AA battery in the duodenum was removed from the rectum at the end of the third day without any complications. However, the continuous movement of the cylindrical AA battery with lactulose treatment in the gastrointestinal tract and the support of this movement with abdominal radiographs can reduce the risk of fatal complications. When planning the battery treatment in the gastrointestinal tract, the location of the battery and whether it is mobile should be determined. While obstruction of oesophagus by batteries requires emergency surgical treatment, batteries that remained fixed in the stomach for longer than 48 hours need to be treated with surgical or endoscopic methods.

Incidence and mortality results of intestinal obstruction in geriatric and adult patients: 10 years retrospective analysis.

Objectives: People with ileus is one of the patient groups with the highest admission rates to the emergency departments. In this study, it was aimed to determine the effects of age groups and etiological factors on mortality when evaluated together with gender. Material and Methods: In our study, patients who were consulted from the Emergency Service to the General Surgery department with a pre-diagno- sis of abdominal pain between 2009 and 2020 were retrospectively screened. Patients hospitalized for ileus were analyzed in terms of age (18-65 years and over 65 years), gender, operation, etiology, incidence, and mortality. Results: Between 2009 and 2020, 534 (3.03%) of 17.601 patients who received emergency consultation from the general surgery clinic were diagnosed with ileus. While 253 (47.4%) of the patients were operated, 317 (59.4%) patients and 101 (18.9%) patients were diagnosed with brid and malignancy, respectively; and 21 (3.9%) patients died in the complete patient group (Table 1). While the incidence of brid was high in non-operated patients, in operated patients, malignancy and other pathologies was found to be higher (p <0.001) (Table 2). While, in patients 65 years and older, mortality was observed in 10.6% of women and 2.6% of men, it was determined that the mortality rate was higher in women (p= 0.008) (Figure 4). Conclusion: The mortality rate in patients hospitalized with the diagnosis of mechanical bowel obstruction was found to be statistically significantly higher in female patients aged 65 and over.

Retrospective evaluation of the effects of sugammadex and neostigmine on the IgE and eosinophil cationic protein in morbid obese patients.

OBJECTIVE: This study was designed to show that allergic reactions with gamma cyclodextrin-related caused by sugammadex are not anaphylaxis but an anaphylactoid reaction. METHODS: In this retrospective study, 83 morbidly obese patients, who underwent elective laparoscopic sleeve gastrectomy operation, were included. Patient data were obtained from patient files and electronic health records system (SARUS). The patients were divided into two groups as sugammadex (Group S) and neostigmine (Group N). Patient data were recorded, including patient preoperative demographics (age, gender) and preoperative and postoperative (12 hours later) levels of total IgE and ECP (Eosinophil cationic protein) levels. RESULTS: There was not a significant change in the total IgE levels in Group S or Group N (p>0.05); however, the levels of ECP significantly decreased in both groups (p<0.001, p=0.01). In the patients in Group S, the preoperative levels of total IgE were significantly positively, and weakly correlated with the preoperative ECP (p=0.311, p=0.045) and postoperative ECP (p=0.310, p=0.046) levels. CONCLUSION: Allergic reactions that arise from sugammadex related with gamma-cyclodextrin are non-IgE mediated anaphylactoid reactions. Anaphylactoid reaction was not observed after administration of 2 mg kg-1 sugammadex intravenously in patients with morbid obesity.

Spontaneous direct inguinal hernia rupture and intestinal mesenteric separation: A case report.

Spontaneous evisceration is a rare complication that becomes life-threatening in direct inguinal hernia. A female at the age of 44, weighing 50 kg looked cachectic and was suffering from swelling on the left groin for the last several years. The evisceration of the small intestine as separated from the mesenterium transpired in the subsequent stage of a spontaneous rupture in the left inguinal region after severe coughing. The region ruptured was sealed after small intestine resection carried out through the incision perforated; mesh herniorrhaphy was implemented at the end of the 3rd month. The spontaneous rupture may transpire depending on malnutrition and cachexia not only after the complications by hernia, such as incarceration, strangulation but also after factors increasing intra-abdominal pressure. Elective surgical treatment must be implemented in hernia regardless of its kind. Complications likely to transpire in cases where intervention is conducted too late may threaten the patient's life.

Successful treatment of a hepatic abscess formed secondary to fish bone penetration by laparoscopic removal of the foreign body: report of a case.

Although foreign body ingestion is a common problem in children, it is also seen among adults. Perforation of the gut by a foreign body, followed by migration of the foreign body to the liver is quite rare. Most fish bone ingestions have uneventful outcome. However, occasionally, it can cause serious complications if the gastrointestinal tract is perforated. Herein, a case of liver abscess caused by a fish bone is reported. To the best of our knowledge, it is the first case in our country.

Thrombospondin 1 expression and angiogenesis in breast carcinoma and their relation with platelet activity.

This study investigates angiogenesis and the expression of thrombospondin 1 in invasive ductal carcinoma of the breast and their possible relation to platelet counts and platelet activity. The study included 20 cases of invasive ductal carcinoma. Platelet activity was evaluated by determining thromboxane B2 and cyclic guanosine monophosphate (cGMP) levels by enzyme immunoassay (EIA).Thrombospondin (TSP) 1 and CD34 expression was studied immunohistochemically. Mean platelet count of the patient group was significantly greater than the mean platelet count of the control group (P < 0.05). The platelet counts were positively correlated with tumour size (r=0.609; P < 0.01). Platelet counts were higher in the patients who had grade 3 microvessel density (P < 0.05). The mean basal platelet cGMP level in the patient group was significantly lower than it was in the control group (P < 0.05). Focal TSP immunoreactivity was detectable in 5 (20%) cases in the tumour cells, and in 9 (45%) cases in the stroma. We did not find any correlation between TSP-1 staining and angiogenesis, platelet counts, platelet activity, and the histological prognostic parameters. Our study confirms the essential role of platelets in tumour growth and angiogenesis. Decreased levels of cGMP in the patient group may cause platelet hyperreactivity. Although thrombospondin 1 may be upregulated in malignant breast tissue, this is not sufficient for tumour growth and dissemination according to our results.

Recurrent hepatic hydatid cyst in a pregnant woman.

BACKGROUND: Hydatid cyst in pregnancy is a very rare pathology and its diagnosis and treatment is still a complex problem. This report describes the clinical features and evolution of a pregnant woman operated for a recurrent hepatic hydatid cyst. CASE REPORT: A 26-year-old multigravida was admitted to our hospital in her 16th week of pregnancy because of dyspeptic complaints. She had had previous operations for hydatid cyst. A 7x5x6 cm recurrent hepatic hydatid cyst and cholelithiasis were diagnosed on sonographic evaluation. Partial cystectomy, external drainage, and cholecystectomy were performed in the second trimester of her pregnancy. No complication occurred and she gave birth to a healthy baby five months later. CONCLUSIONS: Every physician working in endemic areas should be aware of this potential healthy problems because a hydatid cyst can cause severe complications and be fatal to both mother and baby.