The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas.

BACKGROUND: There is no consensus regarding the standard treatment method for anorectal abscesses accompanied by anal fistulas and complex anal fistulas. Simultaneous surgical treatment of the underlying anal fistula with anorectal abscess drainage is controversial due to incontinence problems. OBJECTIVES: We aimed to investigate the effectiveness of the loose seton method for the treatment of chronic anal fistulas and acute anorectal abscesses accompanied by anal fistula. MATERIAL AND METHODS: In this retrospective study, 114 patients who were operated on in our clinic due to chronic anal fistulas and anorectal abscesses with an applied loose seton between 2020 and 2022 were included in the study. The patients were divided into 2 groups: those with chronic complex anal fistula and those with anorectal abscess accompanied by anal fistula. The groups were compared in terms of their continence status, rate of recurrence, recurrent abscess formation, postoperative pain scores, duration of operation, and demographic characteristics. RESULTS: Of the patients included in the study, 78 had a complex chronic anal fistula, and 36 had an anorectal abscess accompanied by an anal fistula. There were no differences between the demographic characteristics of the 2 groups. The mean seton dissociation time was 6.8 (3-19) months. Gas or stool leakage was not observed in patients during the mean follow-up period of 18 (6-30) months. There was no difference in postoperative continence levels between the 2 groups. No recurrent fistulas were observed in patients during the follow-up period. Recurrent abscesses were observed in 5 (13.9%) patients in the anorectal abscess group. Abscesses due to insufficient drainage were observed in 2 (2.6%) patients in the chronic fistula group. There was no significant difference in operation time between the 2 groups. CONCLUSION: A loose seton can be a safe and effective method for the treatment of abscesses. It is a painless surgical method that produces good results in the treatment of all types of abscesses.

Preventive effect of fucoxanthin administration on intra-abdominal adhesion: An experimental animal study.

BACKGROUND: The most common cause of intra-abdominal adhesion (IAA) is previous abdominal surgery and mortality. IAA can cause serious complications such as chronic abdominal pain, ileus, and infertility. Approximately 3% of all laparotomies are related to adhesions. IAA reduces the quality of life of the patient, causes morbidity, and increases health expenditures. In this study, we aimed to investigate the preventive effect of fucoxanthin (Fx) on IAA in the intra-abdominal surgical adhesion model that experimentally created in rats. METHODS: This study used 21 Sprague-Dawley rats divided into three groups. After anesthesia, the abdomen was opened, the cecum and right abdominal wall were damaged with a sterile toothbrush until petechiae bleeding was seen. No additional action was taken to the control group. In the sham group, 5 cc saline solution was released into the peritoneum before the abdomen was closed. In the Fx group, 35 mg/kg Fx was instilled intraperitoneally and the abdomen was closed. On the 21st post-operative day, all subjects were anesthetized with standard anesthesia. Macroscopic adhesions were quantitatively evaluated according to the Mazuji classifica-tion. The cecum anterior wall and parietal peritoneum were excised for pathological sampling. A pathologist, unaware of the groups, evaluated inflammation, fibroblastic activity, and vascular proliferation. In addition, serum tumor necrosis factor-alpha (TNF-α) and interleukin-10 levels were measured. RESULTS: No rat was lost during the study period. Congenital adhesion was not observed in any of the subjects at the first laparo-tomy. Adhesion was significantly less macroscopically in the Fx group compared to the control and sham group (p<0.001 and p<0.001). Fibroblastic activity was found to be significantly less in the Fx group compared to the sham and control groups (p<0.001 and p<0.001). Vascular proliferation was found to be significantly less in the Fx group than in the sham and control groups (p<0.001 and p<0.001). The inflammation score was significantly lower in the Fx group compared to the other two groups (p<0.001 and p<0.001). The inflam-mation score in the sham group was lower than the control group and was statistically significant (p<0.001). TNF-α level was found to be statistically significantly lower in the Fx group compared to the sham and control groups (p<0.001 and p<0.001). CONCLUSION: As a result of experimental study, we can say that Fx is effective in preventing IAAs and decreases the level of TNF-α, a pro-inflammatory cytokine.

The prognostic value of preoperative PET/CT evaluation of maximum standardized uptake value in renal cell carcinomas.

AIM: The use of positron emission tomography (PET/CT) in kidney tumors has increased greatly in recent years. There have been few studies on the effect of SUVmax values detected by PET/CT on the mortality and survival estimation in patients with kidney tumors. In this study, it is hoped to contribute to the literature of research on survival and mortality estimations of kidney tumour patients through an evaluation of SUVmax values measured with PET/CT scan. MATERIAL AND METHODS: A retrospective review was made of the files of 21 patients newly-diagnosed with kidney tumor and with disease staging determined with PET/CT in the Nuclear medicine Department of Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital between August 2007 and April 2012. The largest tumor seen on CT was considered as the tumour size and was stated in cm. The survival time was defined as the time from the date of PET/CT Imaging, which was taken into consideration while calculating the survival, and the date of death received from MERNIS (The Central Civil Registration System) or the final application date if the patient was alive. RESULTS: The lower the SUVmax value in the kidney tumour, the longer the survival time. The mortality risk of male patients was 12-fold higher than females and mortality increased 4-fold when SUVmax values were ≥ 4.5.Patients with a tumour on the right kidney had a longer survival time. With increasedage,survival time decreased. The SUVmax values and tumor size measured in left kidney tumors were higher than those measured in right kidney tumors. CONCLUSIONS: In the present study, it was concluded that the lower the SUVmax values and the smaller the tumour size, the longer the survival time. Mortality rates increased when SUVmax values were ≥ 4.5 (p=0.001).The use of PET/CT scan can be considered to contribute to mortality and survival estimations in patients with kidney tumor. KEY WORD: FDG, Renal cell Carcinoma, SUVmax.