[A rare cause of bleeding intestinal intussusception in adult: jejunal lipoma]. / Eriskinde nadir bir intestinal intussusepsiyon ve kanama nedeni: Jejunal lipom.

Small bowel neoplasms are usually diagnosed when patients are referred with complications such as hemorrhage or obstruction. Intestinal lipomas are the third most frequent benign tumors among all intestinal neoplasms and their definite diagnosis is usually obtained after histopathological examination of the resected specimen. A 76 year-old male patient with partial intestinal obstruction and rectal bleeding at admittance was found to have an abdominal mass on ultrasound. The density pattern of the mass at abdominal CT was supporting a jejunal lipoma leading an intussusception. Then an enteroclysis localized and reduced the jejunojejunal intussusception. The diagnosis of lipoma was confirmed with histopathological examination of the mass removed by an elective intestinal resection. This case was reported as the intestinal lipoma leading a jejunojejunal intussusception associated with bleeding, could be diagnosed preoperatively.

Organ models in wound ballistics: experimental study.

BACKGROUND: Effects of various types and diameters of guns and related treatment principles are different. Our study was performed to experimentally demonstrate the effects of different gunshots in body tissues. METHODS: 9x19 mm hand-gun and 7.62x51 mm G-3 infantry rifle were used in the study. Injury models were created through hand-gun and rifle shootings at isolated soft tissue, lower extremity, liver and intestine tissue simulants made of ballistic candle. High-speed cameras were used to capture 1000 frames per second. Images were examined and wound mechanisms were evaluated. RESULTS: It was observed that the colon content distributed more within the surrounding tissues by the rifle shootings comparing with hand-gun shootings and could be an infection source due to the large size of the cavity in the colon. Especially when the bullets hitting the bone were investigated, it was seen that much more tissue injury occurs with high speed bullets due to bullet deformation and fragmentation. However, no significant difference was found between the effect of hand-gun and rifle bullets passing through the extremity without hitting the bone. CONCLUSION: To know the type of the gun that caused the injury and its characteristics will allow to estimate severity and size of the injury before the treatment and to focus on different alternatives of treatment. Therefore, use of appropriate models is required in experimental studies.

Endothelial dysfunction and fetuin A levels before and after kidney transplantation.

BACKGROUND: Endothelial dysfunction (ED) has a major role in the cardiovascular outcome of patients with chronic kidney disease (CKD). The aim of this study was to investigate the relation between fetuin A levels and ED in kidney transplant recipients. METHODS: Forty-two living donor kidney transplant recipients, 21 (11 male) on cyclosporine A and 21 (10 male) on tacrolimus-based regimes, were studied. Forty-two (21 male) healthy subjects were enrolled as controls. Fetuin A, highly sensitive C-reactive protein (hsCRP) levels, brachial artery endothelium-dependent vasodilatation (FMD), nitroglycerine mediated dilatation (NMD), and carotid intima-media thickness (CIMT) were measured before transplantation and on the 30th and 90th days posttransplant. RESULTS: Pretransplantation serum fetuin A concentrations and FMD values of patients were significantly lower than those of the controls (P<0.001 for both). These were significantly increased in the 30th and 90th days posttransplantation There was a significant positive correlation between Fetuin A and FMD levels both before and after kidney transplantation (r=0.534, r=0.576; respectively, P<0.001 for both). Carotid intima-media thickness and hsCRP levels decreased after transplantation (P<0.001 for all). According to the regression analysis, fetuin A, intact parathyroid hormone, and hsCRP levels were the independent determinants of FMD. CONCLUSION: The results of the present study suggest that low serum fetuin A levels in CKD may contribute to impaired endothelial functions in CKD. Future studies should clarify the role of fetuin A levels in cardiovascular outcomes of CKD.

Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery.

BACKGROUND: The effect of pneumoperitoneum on veins of the lower limbs related to the intra-abdominal working pressures during laparoscopic cholecystectomy has not been thoroughly investigated. We tested the hypothesis that working pressures do not affect the venous haemodynamics in the lower limbs. METHODS: The cross-sectional area and peak flow rates of femoral and saphenous veins in the right groin were measured in 60 patients divided into two groups according to the intra-abdominal working pressures (11 vs 14 mmHg). All measurements were carried out preoperatively and at predetermined periods during and after laparoscopic cholecystectomy by colour Doppler ultrasonography. One-way anova and chi(2) test were used for the analysis of demographic data. For the repeated measures, anova and Student's t-test were used for statistical analysis. The probabilities less than 0.05 were accepted as statistically significant. RESULTS: The cross-sectional area of the veins increased, whereas the peak flow rate in veins decreased during pneumoperitoneum. Comparing the peak flow rate in the saphenous vein at the third intraoperative measurement, there is statistically significant difference between the two groups (P < 0.05). CONCLUSION: The degree of intra-abdominal pressure affects the haemodynamics of the peripheral veins. Pneumoperitoneum during laparoscopy causes stasis in the peripheral veins. It is reasonable to use routine prophylaxis for deep vein thrombosis, in the light of these findings.

Intracolonic multiple pebbles in young adults: radiographic imaging and conventional approach to a case.

Most of the foreign bodies detected in adult gastrointestinal systems are accidentally swallowed pins. In this study, we presented a case with intracolonic multiple pebbles. A 20-year-old man was admitted to emergency surgery policlinic for abdominal pain for 2 d without any alleviation or aggravation. His upright plain abdominal radiographic imaging revealed about 30-40 overt dense opacities in lumen of colonic segments, with oval and well shaped contours, each approximately 1 cm multiply 1 cm in size. The multiplanar reconstructions and three-dimensional images combined with sectional screening showed that all pebbles had passed completely into the colon and no foreign bodies had remained in the ileal segments. On psychiatric assessment, he was found to have immature personality features, difficulty in overcoming stressors and adaptation disorder. He recovered by conservative management and radiographic monitoring applied during his follow-up. Thus, it can be concluded that, in differential diagnosis of abdominal pain in adult ages, though less frequently seen than in children, gastrointestinal system foreign bodies should always be kept in mind and it should be considered that ingestion of pebbles may be one of the factors contributing to abdominal pain particularly in young adults with psychiatric problems. In such cases suspected of having foreign bodies which cannot be detected by plain films, abdominal tomography can be an alternative for diagnostic imaging.

Abdominal heterotopic tissues: review of 24 cases diagnosed on postoperative histological evaluation.

BACKGROUND/AIMS: Heterotopy is defined as abnormal localization of well-differentiated tissue. Heterotopic tissues usually tend to be asymptomatic and noncomplicated but sometimes may cause serious clinical problems. Malignancy potential is the most important issue in this clinical entity. In this study we reviewed medical records of 24 patients with heterotopic tissues. METHODS: Between 1995-2004, 24 patients with heterotopic tissues who were diagnosed during gastrointestinal system or abdominal wall surgery or upper gastrointestinal endoscopy were included in this study. Patients' medical data were retrospectively reviewed. RESULTS: Sixteen patients with heterotopy were younger than 30 years and eight patients were older than 30 years. Nineteen (0.21%) heterotopic tissues were diagnosed in 8,945 patients who underwent gastrointestinal system surgery or upper gastrointestinal endoscopy, whereas five (0.21%) heterotopic tissues were diagnosed in 2,320 patients who underwent abdominal wall surgery. Overall, 24 (0.21%) heterotopic tissues were found in a total of 11,265 patients. The majority were pancreatic heterotopy, followed in decreasing order by gastric, adrenal and osseous heterotopy. In patients who underwent gastrointestinal surgery-endoscopy, pain was the main symptom (n=13)(68.4%), followed by dyspepsia (n=3)(15.7%) and vomiting- nausea (n=2)(10.5%). The main symptom in patients who underwent abdominal wall surgery was palpable mass. heterotopic tissues presented as wall thickening in 13, polypoid mass in five and whole solitary mass or intraparenchymal lesion in six patients. CONCLUSION: Although incidence of heterotopic tissues is low, in case of its suspicion or diagnosis, early treatment should be performed by surgical or endoscopic resection or patients must be followed up carefully due to risk of malignancy.

Giant unilateral abdominoscrotal hydrocele in association with crossed testicular ectopia.

Abdominoscrotal hydrocele and transverse testis ectopia are rare clinical conditions. This case report describes the combination of these two rare entities. An azoospermic and infertile adult man presented with left abdominoscrotal hydrocele and a right impalpable testis. He was treated with left orchiopexy, right orchiectomy, and excision of the abdominoscrotal hydrocele. We discuss the diagnosis and treatment of this combination, which has not been previously reported.

Assessment of oxidative stress in the early posttransplant period: comparison of cyclosporine A and tacrolimus-based regimens.

BACKGROUND: Oxidative stress is one of the leading causes of cardiovascular morbidity and mortality in chronic kidney disease. Although it is clear that many metabolic abnormalities improve, the effects of kidney transplantation on oxidative state are obscure. METHODS: Twenty-three kidney transplant patients were included in the study. Eleven patients (mean age 27.9+/- 9.1 years) were treated with cyclosporine A (CsA) whereas 12 patients (mean age 22.4 +/- 3.4 years) were treated with tacrolimus. Twenty-three healthy subjects served as controls. None of the patients or controls suffered from diabetes mellitus or an acute infection at the time of the study. Plasma malondialdehyde (MDA), plasma selenium (Se), erythrocyte glutathione peroxidase (GSH-Px), erythrocyte superoxide dismutase (SOD), erythrocyte Zn (EZn), and erythrocyte Cu (ECu) levels were studied before and in the 1st, 3rd, 7th, 14th and 28th days after the transplantation. RESULTS: The GSH-Px, SOD, ECu, EZn and selenium levels were lower and MDA levels were higher in patients than controls before transplantation (p < 0.001 for all). MDA levels decreased and SOD, GSH-Px, ECu, EZn levels increased in parallel to the decrement of serum creatinine levels following the renal transplantation. No difference was found among the patients regarding the treatment regime. CONCLUSION: The study data suggest that the improvement in oxidative state parameters begins at the first day of renal transplantation and continues at the 28th posttransplant day in living donor transplantations.

Increased damage from rifle wounds of the chest caused by bullets striking commonly carried military equipment.

BACKGROUND: The purpose of this study was to investigate the fragmentation effect of the bullet that passes through the radio or ammunition magazine, which are essential pieces of equipment for a soldier, in thoracic gunshot injuries. METHODS: Twelve adult pigs were used. The pigs were separated into three groups (each group contained four pigs). The first group was shot without any obstacle between muzzle and subject. The second group was shot through a cartridge magazine placed in front of the subject's thoracic cage. The third group was shot with a radio in front of the subject's thoracic cage. RESULTS: It was observed that there was a large bullet entrance and fragmentation in the pigs that were shot with a radio or magazine placed over them, and there was no fragmentation in those that were shot without any obstacle. CONCLUSION: Metal equipment that soldiers carry causes bullet fragmentation. Fragmented bullets may cause excessive tissue disruption of intrathoracic vital organs.

[Comparison of primary colonic anastomosis and colostomy in experimental localized fecal peritonitis]. / Deneysel lokalize fekal peritonitte primer kolon anastomozu ile kolostominin karsilastirilmasi.

BACKGROUND: To investigate the appropriate surgical method that should be selected in the localized fecal peritonitis due to colonic injuries with 24 hours delay. METHODS: Colonic injuries were performed in 35 rats and the repairs were carried out after 24 hours. Seven rats (%20) died of generalized peritonitis in this period. The remaining 28 rats in which fecal peritonitis were localized by surrounding organs, were randomized in two groups: colostomy (n=14) and primary anastomosis (n=14). Intraabdominal complications and 15 days mortality were assessed. RESULTS: The groups had similar results according to intraabdominal complications. The 15 days survival was 71.4 % for the colostomy group and 78.5 % for the anastomosis group (p=0.31) CONCLUSION: If the injured or perforated colon is surrounded by the organs and so the generalized peritonitis is avoided, primary anastomosis would have similar results with colostomy despite fecal contamination and prolonged intervention time.

[Comparison of soft tissue and bone injuries caused by handgun or rifle bullets: an experimental study]. / Tabanca ve piyade tüfegi mermileri ile olusturulan yumusak doku ve kemik yaralanmalarinin karsilastirilmasi: deneysel çalisma.

OBJECTIVES: The aim of this study was to investigate the factors that influence the severity of soft tissue and bone injuries occurring in gunshot traumas and to compare the effects of handgun and rifle bullets on these injuries. METHODS: Sixteen tissue simulants which were made of transparent gel candle blocks and calibrated to muscle tissue were targetted by pistol (9 mm parabellum) or military rifle (G-3) bullets. Half of the blocks contained fresh calf humerus bone. The effects of the bullets in tissue simulants were monitored by using high velocity cameras capable of taking 1,000 views per second. RESULTS: On a millisecond time scale, handgun bullets produced a small-sized temporary cavity while rifle bullets produced a wide temporary cavity in isolated soft tissue simulants. It was shown that the differences in the size of temporary cavities resulting from the blast effect correlated highly with the severity of injury occurring in soft tissues. In samples at which calf humerus bone was targetted, we observed that fragmentation and cavity effects correlated highly with the velocity of the bullet and determined the severity of injury. CONCLUSION: Experimental demonstration of differences in the size and severity of injuries caused by handgun or rifle bullets may have significant implications in the planning of treatment.

A new ballistic simulant "transparent gel candle" (experimental study).

BACKGROUND: Inanimate tissue stimulants have been used to show the bullet effects in ballistic studies. Gelatin has been being used as a ballistic stimulant for the last 20 years. It was considered that transparent gel candle (kraton in white paraffin oil) might be used as a soft tissue stimulant that can be an alternative for gelatin. METHODS: For calibration of transplant gel candle, firstly it was shot at the 10% ordinance gelatin at 4 o C, and several concentrations of the transparent gel candle at 4 o C, by later on, by using a competition air gun. It was seen that 15% kraton in 85% white paraffin oil is the most suitable concentration. This kind of transparent gel candle blocks tested by using 9 mm parabellum and 7.62 mm x 51 (NATO 7.62) infantry rifle bullets and high-speed camera. RESULTS: Because of its transparency and elasticity, the penetration, permanent and temporary cavities of bullets were observed clearly in transparent gel candle. CONCLUSIONS: As a result, transparent gel candle is a good soft tissue stimulant that it can be used in wound ballistic studies.

The magazine: a major cause of bullet fragmentation.

The fragmentation impact of high-velocity bullets penetrating the body after piercing through the magazines carried by soldiers was investigated experimentally. In this study, 16 pigs and 7.62x51-mm full metal jacket bullets were used. Pigs were assigned into two groups, and within 5 minutes of their being sacrificed with overdose anesthesia, bullets were fired into the first group on which magazines were placed and into the second group on which magazines were not placed, targeting abdominal left lower quadrant. It was found that in pigs not carrying magazines, all bullets pierced through the pig; bullets were not fragmented. However, in pigs with magazines, common fragmentation in bullets and multiple organ perforations occurred. It was concluded that magazines caused the bullets to be fragmented, increasing tissue and organ damage.