Sleeve gastrectomy in situsinversustotalis case.

Laparoscopic sleeve gastrectomy surgery is a procedure that has become more common in the past 10 years. Situsinversustotalis is an extremely rare condition. SG can be performed safely in SIT patients. However, pre-operative multidisciplinary evaluation is very important. In this article, we present a 25-year-old female patient with a body mass index of 47.6 who had no idea that she had SIT until pre-operative tests revealed it. The patient was discharged on the 3rd post-operative day without any problem. We would like to emphasize the importance of imaging even if the patient does not have any disease or risk before bariatric surgery. We believe that more studies should be done with SIT and bariatric surgery.

Incidental detection of gastrointestinal stromal tumors during laparoscopic sleeve gastrectomy. What to do?

INTRODUCTION: We evaluated and characterized the incidental GISTs during laparoscopic sleeve gastrectomy in our clinic. METHODS: All GISTs identified during laparoscopic sleeve gastrectomy between January 2015 and December 2017 were evaluated. Typical demographic, clinicopathologic, treatment, location, resection margins, immunohistochemistry (CD 34, CD 117, ASMA, desmin and S100) and criteria for oncological aggressiveness (tumor size, number of mitoses, presence or absence of tumor necrosis) data were recorded. RESULTS: Within the 800 bariatric surgeries at our institution, 7 GISTs were identified (0.87%). The median age of the patients was 32 years (age range: 24-42 years). The mean BMI was found to be 40.66 kg/m2 (range: 35-44 kg/m2). All GIST cases were found in the stomach samples. All tumors were not larger than 20 mm. All tumors were found close to the greater curvature of the stomach; in five cases, tumors were located in a single focus, while in 1 case, it was located both in the corpus and fundus. CD117 and CD34 were found to be positive in the pathological examination of all parts. In addition, desmin, smooth muscle actin (SMA) and S-100 were also positively stained. No complications or mortality were observed in this series. CONCLUSION: Tumor resection with a negative surgical margin may be considered complete oncologic treatment in case of presence of very low or low risk classification of postoperative GIST recurrence. After GIST resection, all patients should remain under long-term postoperative care. KEY WORDS: Bariatric surgery, Incidental gastrointestinal stromal tumors, Obesity, Sleeve gastrectomy.

Effect of platelet-rich plasma on healing in laser pilonidoplasty for pilonidal sinus disease.

The aim of this study was to evaluate the effects of application of platelet-rich plasma in addition to laser pilonidoplasty for the treatment of pilonidal sinus. Twenty-five patients who were treated by laser pilonidoplasty for pilonidal sinus (group 1) and 25 patients who were treated by platelet-rich plasma in addition to laser pilonidoplasty (group 2) at this clinic were included in the study. Patients were classified according to the Irkorucu and Adana Numune's classification and treatment concept. Duration of stay of the patients in the hospital, time to start daily activities, duration of wound healing, recurrence, and complications were evaluated. Among the 50 patients included in the study, 41 (%82) were males and 9 (%18) were females. The mean age was 25.6 ± 2.4 years and 24.8 ± 3.8 years in groups 1 and 2, respectively. The locations of the pilonidal sinus were similar in the two groups. No statistically significant differences were found in the duration of hospital stay, duration of the procedure, time to return to work, and complication rates between the two groups. Nevertheless, duration of wound healing was 6.1 ± 2.3 and 4.1 ± 0.9 weeks in groups 1 and 2, respectively, and was shorter in group 2. Duration of wound healing was statistically significantly different in the two groups. We concluded in this study that application of platelet-rich plasma in addition to laser pilonidoplasty significantly shortens the time of wound healing.

Surgical approach in adrenal incidentalomas: Report of thirteen cases and review of the literature.

OBJECTIVE: The rate of adrenal incidentalomas detected in routine diagnostic imaging techniques is approximately 4-7%. Although the lesions are generally benign, carcinoma and functional adenomas can be diagnosed with careful clinic and laboratory evaluation. MATERIAL AND METHODS: Data of 13 patients who underwent surgery for an adrenal mass between January 2010-June 2014 were analyzed retrospectively. RESULTS: Seven (54%) patients were male, 6 (46%) were female, and the mean age was 38.2. The clinical diagnosis was pheochromacytoma in 5 patients (38.4%), non-functional adenoma in 5 (38.4), and metastatic lesion, Cushing syndrome, and adrenal carcinoma each in one patient (7.6%). Conventional open adrenalectomy was performed in 8 patients, while 5 patients underwent laparoscopic adrenalectomy. CONCLUSION: Adrenal incidentalomas should be carefully evaluated for hormonal activity even if asymptomatic, and non-functional lesions should be considered as suspicious-for-malignancy. Laparoscopic adrenalectomy has become the gold standard for patients with a mass less than 6 cm, and without infiltration to adjacent organs.

Comparing sutures and human fibrin glue for mesh fixation during open inguinal hernioplasty.

PURPOSE: The aim of this study is to evaluate pain and further disabling complications in patients undergoing Lichtenstein technique for primary inguinal hernia repair by fixing the mesh with fibrin sealant versus sutures. METHODS: This study was carried out on 116 patients between January 2009 and July 2009. All patients were male, between the ages of 20 and 75 years. Lichtenstein, using a polypropylene mesh as prosthetic material. A total of 116 hernias were operated on. Group I: 54 operations were done using the conventional repair procedure with polypropylene sutures (prolene 2/0) for mesh fixation. Group II: 62 operations were done using fibrin glue for fixation of the mesh. All patients were operated as day cases, with a maximum hospital stay of 12 hours; none required readmission. RESULTS: No complications were observed in follow-up at 1 week, 1 month, 6 months and 12 months. At 12 months, none of the patients had developed a recurrence. The mean time for complete healing of wound after herniorrhaphy plus fibrin sealant was 8.13±7.88 days (range 6-28 days). This was markedly increased in group 1 patients (mean 12.08±8.59days, and range 8-32) (p <0.001).12 months after surgery, The median VAS pain score was significantly lower in group 2 patients (P < 0·001). The mean (SD) duration of incapacity for work was 5 (2-12) days in group 2(p <0.001). CONCLUSIONS: This study confirms the effectiveness of fibrin glue in securing prosthetic meshes and reducing chronic inguinal pain. KEY WORDS: Chronic pain, Fibrin glue, Inguinal hernia repair.

Does hyperbaric oxygen therapy reduce the effects of ischemia on colonic anastomosis in laparoscopic colon resection?

BACKGROUND: An increase in intra-abdominal pressure causes a decrease in the splanchnic blood flow and the intramucosal pH of the bowel, as well as increasing the risk of ischemia in the colon. The aim of the present study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the ischemia caused by laparoscopy in colonic anastomosis in an experimental model of laparoscopic colonic surgery. MATERIALS AND METHODS: We divided 30 male Wistar albino rats into three groups: Group A was the control (open colon anastomosis); Group B received LCA (laparoscopic colon anastomosis); while Group C received both LCA and HBOT. Each group contained ten animals. We placed Group C (LCA and HBOT) in an experimental hyperbaric chamber into which we administered pure oxygen at 2.1 atmospheres absolute 100% oxygen for 60 min for ten consecutive days. RESULTS: The anastomotic bursting pressure value was found to be higher in the open surgery group (226 ± 8.8) (Group A). The result for Group C (213 ± 27), which received HBOT, was better than that for Group B (197 ± 27). However, there was no statistically significant difference between Group B and Group C. Group A showed better healing than the other groups, while significant differences in the fibroblast proliferation scores were found between Groups A and B. In terms of tissue hydroxyproline levels, a significant difference was found between Groups A and B and between Groups A and C, but not between Groups B and C. CONCLUSIONS: HBOT increases the oxygen level in the injured tissue. Although HBOT might offer several advantages, it had only a limited effect on the healing of colonic anastomosis in rats with increased intra-abdominal pressure in our study. KEY WORDS: Anastomosis, Colon, Hyperbaric Oxygen Treatment, Oxidative Stress.

Can isolated pancreaticojejunostomy reduce pancreas fistula after pancreaticoduodenectomy with Roux-en-Y reconstruction?

OBJECTIVE: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method. MATERIAL AND METHODS: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb. RESULTS: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group. CONCLUSION: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas.

Effective conservative treatment of umbilical pilonidal sinus disease: Silver nitrate? Salt?

OBJECTIVE: The aim of this study was to compare the three different treatment methods and investigate The effectiveness of the therapeutic effect of common salt. METHODS: This retrospective study involved patients who were treated in our clinic for umbilical pilonidal sinus disease between January 2010 and December 2011. The patients were divided to three subgroups according to treatment methods. Group I: Cases treated with only local debridement and systemic antibiotic, group II: cases treated with local debridement, systemic antibiotic and silver nitrate, group 3: cases treated with debridement, systemic antibiotic and salt. RESULTS: In this study, 63 patients with the diagnosis of UPS were treated in our clinic. The patients were classified into three groups; group I included 20 patients, group II included 18 patients and group III included 18 patients. During 16-24 months of follow-up, 4 (20%) recurrences in group1 and 2 (11.1%) recurrences in group 2 were detected. Recurrence rate of group 3 was significantly different (5.55%) when compared to group 2. The mean period for returning to daily activities and work was 1 day for the patients. CONCLUSION: In conclusion, we suggest that pilonidal sinus cases which are not complicated by abcess and cellulitis can be treated by local removal of umbilical hairs, debridement and dressing without surgery. We conclude that application of common salt (table/ cooking salt) to umbilical pilonidal sinus with granuloma is a simple and highly effective way of treatment without any relapse and complications. KEY WORDS: Conservative treatment, Local debridement, Umblical pilonidal sinus.

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history.

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.

Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works.

Obesity and diabetes is a co-pandemic and a major health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease.

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus.

The effect of silymarin on hepatic regeneration after partial hepatectomy: is silymarin effective in hepatic regeneration?

AIM: Silymarin from Silybum marianum was found to reduce liver injury. The aim of the present study was to investigate the effects of silymarin on hepatic regeneration in partially hepatectomized rats. METHODS: Thirty Wistar-Albino rats were divided into 3 groups of 10 animals as sham, control and experimental groups. In the sham group (n=10) abdominal incision was closed after laparotomy. In the control group (n=10), the rats underwent 70% hepatectomy after laparotomy. In the experimental group (n=10) after partial 70% hepatectomy, silymarin (200 mg/kg/d) were given to rats for 10 days. Rats in three groups were sacrificed on 10 days. Aspartate (AST) and alanine transaminase (ALT), gamma glutamyl transferase (GGT), ALP, LDH and total bilirubin levels were measured using intracardiac blood samples. Tissue malondialdehyde (MDA) and tissue glutathion (GSH) and Superoxide dismutase (SOD) levels were measured. To reveal the increase in the mass of the remnant liver tissue in the control and experimental groups relative weight of the liver was calculated. Histopathological analysis of the liver was performed using a semi-quantitative scoring system. RESULTS: A statistically significant difference among three groups was not shown for AST and ALT levels. A statistically significant difference was found between the groups as for total bilirubin and gamma glutamyl transferase levels. Increases in relative liver weights were seen with time in Groups 2 and 3. A statistically significant difference was not found for tissue malondialdehyde, Glutathion and Superoxide dismutase levels between hepatectomy and hepatectomy + silymarin groups. On liver tissue sections of the rats in the hepatectomy + silymarin group, increased regeneration and lipid peroxidation were observed accompanied by decreased antioxidant response. CONCLUSION: It has been observed that silymarin with many established functions such as antiproliferative, anti-inflammatory and energy antioxidant effects, does not contributed to proliferative regeneration of the liver-which has very important metabolic functions -after partial hepatectomy; instead it will decrease serum levels of transaminases.

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus. .

Evaluation of power Doppler sonography in acute cholecystitis to predict intraoperative findings: a prospective clinical study.

BACKGROUND: This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively. METHODS: Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947). RESULTS: Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation, conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%. CONCLUSION: Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.

Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis.

BACKGROUND: Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. PATIENTS AND METHODS: A retrospective case-controlled study was designed in two groups, both containing 100 patients, acute appendicitis and control. Leukocyte count, neutrophil percentage, platelet count and meal platelet volume (MPV) were compared. RESULTS: MPV values for acute appendicitis and control groups were 7.4 ± 0.9 fL (5.6-10.6) and 9.1 ± 1.6 fL (5.1-13.1). For the diagnosis of acute appendicitis, ROC analysis revealed 74% sensitivity and 75% specificity for a cut-off value of 7.95 fL of MPV, however, the diagnostic value of leukocyte count and/or neutrophil ratio was superior. CONCLUSION: Our results suggest that, MPV value is an important parameter in the diagnosis of acute appendicitis, but in terms of sensitivity and specificity, leukocyte count and/or neutrophil percentage is superior.

The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis.

OBJECTIVES: Vardenafil enhances dilatation of vascular smooth muscle and inhibits platelet aggregation. The purpose of this study was to evaluate the clinical effects of vardenafil and pentoxifylline administration in an experimental model of ischemic colitis. METHODS: Forty female Wistar albino rats weighing 250-300 g were randomized into five experimental groups (each with n = 8) as follows:1) a sham group subjected to a sham surgical procedure and administered only tap water; 2) a control group subjected to a standardized surgical procedure to induce ischemic colitis and administered only tap water; 3) and 4) treatment groups subjected to surgical induction of ischemic colitis followed by the postoperative administration of 5 mg/kg or 10 mg/kg vardenafil, respectively; and 5) a treatment group subjected to surgical induction of ischemic colitis followed by postoperative administration of pentoxifylline at 50 mg/kg/day per day as a single dose for a 3-day period. All animals were sacrificed at 72 h post-surgery and subjected to relaparotomy. We scored the macroscopically visible damage, measured the ischemic area and scored histopathology to determine the severity of ischemia. Tissue malondialdehyde levels were also quantified. RESULTS: The mean Gomella ischemic areas were 63.3 mm2 in the control group; 3.4 and 9.6 mm2 in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm2 in the pentoxifylline group (p = 0.0001). The mean malondialdehyde values were 63.7 nmol/g in the control group; 25.3 and 25.6 nmol/g in the vardenafil 5 and vardenafil 10 groups, respectively; and 22.8 nmol/g in the pentoxifylline group (p = 0.0001). CONCLUSION: Our findings indicate that vardenafil and pentoxifylline are effective treatment options in an animal model of ischemic colitis. The positive clinical effects produced by these drugs are likely due to their influence on the hemodynamics associated with vascular smooth muscle and platelet functions.

Outcome analysis of laporoscopic D1 and D2 dissection in patients 70 years and older with gastric cancer.

OBJECTIVE: Gastric cancer is a worldwide aggressive tumor with a bad prognosis. The purpose of this study was to retrospectively investigate operative findings of 53 patients aged over 70 with gastric cancer who underwent laporoscopic operations in our clinic. MATERIAL AND METHODS: A retrospective review of all patients who underwent laporoscopic surgery for pathologically confirmed gastric cancer at our clinic between March 2008 and October 2010 was conducted. D1 resection (Level1 lymphadenectomy) was compared with D2 resection (Levels 1 and 2 lymphadenectomy). The two groups in which D1 and D2 Lymph node Dissection (LND) were applied were compared with respect to number of patients, sex, age, stage of disease, and score of American Society of Anesthesiologists (ASA). We analyzed surgical methods, the use of staplers, operative time, additional organ resections, hospital stay, postoperative complications and the need for re-operation, operative mortality, and the effects of prognostic factors on survival. RESULTS: The patient group consisted of 31 (58%) males and 22 (42%) females. Of the patients, 28 (52%) underwent D1 and 25 (48%) D2 LND. There was a significant difference between the two groups with regard to length of surgery (p < 0.01). The length of operation, blood loss, and transfusion requirement in the D2 group were significantly more than those in the D1 group. There was no mortality in cases that underwent additional organ resection. The survival times of cases with a ≤ 0.25 ratio of dissected number of lymph nodes to metastatic lymph nodes were significantly longer than those of other cases. The survival time of cases with perineural and vascular invasion was significantly shorter. The survival rates of Stage I patients was significantly higher than those of Stage III (p:0.002) and Stage IV (p:0.003) patients. CONCLUSIONS: Although extensive dissection had an increased morbidity, there was no significant statistical difference between the two procedures. Early complications should not be attributed only to the extent of LND. The important prognostic factors related to long-time survival are the stage of the tumor, perineural and perivascular invasion, and metastatic lymph nodes.

The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis

OBJECTIVES: Vardenafil enhances dilatation of vascular smooth muscle and inhibits platelet aggregation. The purpose of this study was to evaluate the clinical effects of vardenafil and pentoxifylline administration in an experimental model of ischemic colitis. METHODS: Forty female Wistar albino rats weighing 250-300 g were randomized into five experimental groups (each with n = 8) as follows:1) a sham group subjected to a sham surgical procedure and administered only tap water; 2) a control group subjected to a standardized surgical procedure to induce ischemic colitis and administered only tap water; 3) and 4) treatment groups subjected to surgical induction of ischemic colitis followed by the postoperative administration of 5 mg/kg or 10 mg/kg vardenafil, respectively; and 5) a treatment group subjected to surgical induction of ischemic colitis followed by postoperative administration of pentoxifylline at 50 mg/kg/day per day as a single dose for a 3-day period. All animals were sacrificed at 72 h post-surgery and subjected to relaparotomy. We scored the macroscopically visible damage, measured the ischemic area and scored histopathology to determine the severity of ischemia. Tissue malondialdehyde levels were also quantified. RESULTS: The mean Gomella ischemic areas were 63.3 mm2 in the control group; 3.4 and 9.6 mm2 in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm2 in the pentoxifylline group (p = 0.0001). The mean malondialdehyde values were 63.7 nmol/g in the control group; 25.3 and 25.6 nmol/g in the vardenafil 5 and vardenafil 10 groups, respectively; and 22.8 nmol/g in the pentoxifylline group (p = 0.0001). CONCLUSION: Our findings indicate that vardenafil and pentoxifylline are effective treatment options in an animal model of ischemic colitis. The positive clinical effects produced by these drugs are likely due to their influence on the hemodynamics associated ...

Crystallized phenol treatment of pilonidal disease improves quality of life.

The effects of crystallized phenol treatment of pilonidal sinus on quality of life has not been investigated before. This study aimed to compare the phenol treatment with surgical excision plus primary closure technique in terms of life quality by means of a life quality questionnaire. This is a prospective randomized clinical study. The study was conducted at Training and Teaching Hospital, Kayseri, Turkey. In total, 40 patients with pilonidal disease were randomly assigned into 2 clinically comparable groups between September 2010 and June 2011. Cristallyzed phenol application was done to 20 patients and surgical excision plus primary closure was done to 20 patients for the treatment of pilonidal disease. Data regarding demographic variables were recorded. To evaluate quality of life and patient comfort all patients asked to fill the questionnaire after complete healing occurred. There was no difference between the groups in age, sex and occupation. Two of the 20 patients in the excision and primary closure group had complication of wound dehiscience and needed prolonged wound care. There was significant differences in favor of the phenol group in all terms of life quality except for complete healing time. As a first degree treatment, phenol treatment is better than the other treatment choices of pilonidal disease in terms of time off work perioperative pain, being away from school and social life. Also phenol treatment can be done without any pretreatment laboratory examination. Further studies will be needed about cost-effectivity of phenol treatment.

Comparison of APACHE II, P-POSSUM and SAPS II scoring systems in patients underwent planned laparotomies due to secondary peritonitis.

BACKGROUND: The first aim of this study was to discuss the factors affecting mortality rate in patients with severe intraabdominal sepsis treated with planned relaparotomy. The second aim was to compare APACHEE II, P-POSSUM and SAPS II scoring systems to allow identification of high-risk patients. MATERIAL AND METHODS: A series of 34 patients who had intra-abdominal sepsis and treated with planned relaparotomy between January 2009 and January 2012 were included the study. The source of the peritonitis, type and number of surgical procedures, number of planned relaparatomies, microbiology surveillance, total intensive care unit (ICU) and hospital stay duration, number of intubated days, morbidity and mortality were analyzed. APACHEE II, SAPS II, P-POSSUM scores and estimated mortality ranges at admission were compared. RESULTS: The mean age was 46 (16-76 years) and 73.5 % (n=25) were male. A total of 119 operations and 50 surgical procedures were performed. The overall mortality rate was 20.6% (n=7). Complications developed in %53 (n=18) of the patients. Mortality was higher in upper GIS leaks (6/20 versus 1/14 patients). Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II and P-POSSUM were 0.958, 0.955 and 0.931, respectively. The highest values for sensitivity (100%) and specivity (85.2%) together were reached in APACHE II, when cut off value for it was set to 20.5. The SAPS II and P-POSSUM physiology scores were correlated with overall hospital stay (p=0.022 r=0.438 and p=0.001 r=0.609 respectively), but this correlation was not found for APACHEE II score (p=0.085 r=0.337). However, all three scoring systems provided clear estimation of ICU stay duration. CONCLUSION: We suggest that, in secondary peritonitis patients reserved for planned relaparotomy, APACHE II is more reliable for prediction of mortality and P-POSSUM scoring system is more reliable for prediction of overall hospital stay duration.