The importance of serum intestinal fatty acid-binding protein for the early diagnosis of acute mesenteric ischemia.

BACKGROUND: Acute mesenteric ischemia (AMI), although relatively rare, is an emergency condition with high mortality rates (60-80%) attributed to lack of early diagnosis. The aim of this experimental study was to observe the changes in serum intestinal fatty acid-binding protein (I-FABP) levels over time in the AMI model by ligating superior mesenteric artery (SMA) in rats and to compare with the serum I-FABP levels of the rats in the control group. METHODS: Twenty rats were randomly allocated into two groups as control and ischemia group. The basal serum I-FABP levels were determined. SMA was isolated by laparotomy in all animals. In the ischemia group, SMA was ligated and intestinal ischemia was formed. Blood was taken from each rat in both groups at 30th, 60th, and 90th min to determine the serum I-FABP levels. The blood results were compared between two groups and were also compared by time in each group. RESULTS: In the ischemia group, serum I-FABP levels were significantly higher than the control group at post-operative 30th, 60th, and 90th min (p<0.01). In comparison with pre-operative serum I-FABP levels, remarkable increases were observed statistically at post-operative 30th, 60th, and 90th min in the ischemia group (p<0.01). In contrast, there was no statistically significant difference within the serum I-FABP levels over time in the control group. The increases of serum I-FABP levels in the ischemia group were directly correlated with the time of ischemia. CONCLUSION: Serum I-FABP levels have increased significantly in the intestinal ischemia and these values have risen progressively over time. Serum I-FABP may be a useful and promising biomarker for the early diagnosis of AMI.

Laparoscopic management of left thoracoabdominal stab wounds: a prospective study.

BACKGROUND: Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW. METHODS: This study included 36 cases of LTSWs with no hemodynamic instability or abdominal tenderness seen between June 2002 and June 2007. After systemic examination and resuscitation of the patients, chest x-ray and focused assessment with sonography for trauma were carried out and then laparoscopic exploration was performed in all cases. RESULTS: Of the 36 cases, 36.1% (n=13) had injuries to the diaphragm and 53.8% (7/13) had associated intraabdominal injuries. Nine (69.2%) of the patients with diaphragmatic injuries, but no hollow organ injuries, were repaired through laparoscopy. The hemopneumothorax was found in 33.3% (n=12) of the patients. No relationship was seen between diaphragmatic injuries and the location of the LTSW and existence of hemopneumothorax. CONCLUSIONS: Laparotomy was required in only 11.1% (4/36) of the cases with LTSWs and 30.8% (4/13) of the cases with diaphragmatic injury. Diagnostic and therapeutic laparoscopy was a sufficient and necessary surgical procedure in cases with a hemodynamically stable LTSW, when emergency surgery (laparotomy or thoracotomy) was not necessary.

Impact of ligating gonadal or adrenal collateral veins with the left renal vein on renal function and histology in right-nephrectomized rats.

BACKGROUND: In cases of trauma to the left renal vein (LRV), its ligation near the inferior vena cava (IVC) is considered, but the consequences are not always good. We investigated the role of collateral venous drainage after ligation of the LRV by studying the renal function and histology after ligation of the LRV near the IVC alone or with ligation of the gonadal or adrenal collaterals, in right-nephrectomized (RN) rats. MATERIAL AND METHODS: Ligation of the LRV near the IVC alone (group 1) or with ligation of the adrenal (group 2) or gonadal (group 3) collaterals was studied in RN Wistar rats (n=18 per group). The renal histopathology (ischemic cortical necrosis) and functional status (urea, creatinine, sodium, and potassium) were compared. RESULTS: In RN rats, the results were better when ligating the LRV near the IVC alone or with the adrenal collaterals [mortality 4/18 (22.2%) and 3/18 (16.7%), respectively] than when ligating the LRV near the IVC plus the gonadal collaterals [mortality 15/18 (83.3%)] (p<0.0001). All early deaths occurred within three days and resulted from serious histopathological (ischemic cortical necrosis) and functional (increased urea, creatinine, and potassium; decreased sodium) renal damage. CONCLUSION: In right-nephrectomized rats, the LRV near the IVC and the adrenal collateral can be ligated, while the gonadal collateral should be preserved.

The effects on diet, anastomotic type, and loxiglumide on gastric emptying following gastrojejunostomy.

PURPOSE: The effects on gastric emptying of feeding with a normal diet (ND), an early high-calorie and hyperosmolar diet (HCHOD) or normal diet plus intraperitoneal loxiglumide (LOX) were investigated in rats with antecolic (ACGJ) or retrocolic (RCGJ) gastrojejunostomy. METHODS: Sixty rats were separated into six groups of ten animals each (ACGJ+ND, RCGJ+ND, ACGJ+HCHOD, RCGJ+HCHOD, ACGJ+ND+LOX, and RCGJ+ND+LOX). On the seventh day, scintigraphic measurements of solid gastric emptying were made at 1, 30 and 60 min. RESULTS: According to the 60-min results, the RCGJ+ND group exhibited delayed emptying compared to the ACGJ+ND group (p=0.023). Gastric emptying of ACGJ+HCHOD rats was delayed compared with the other ACGJ groups (compared to ACGJ+ND: p=0.000, and ACGJ+ND+LOX: p=0.015). Gastric emptying was more effective in the RCGJ+ND+LOX group than the other RCGJ groups (compared to RCGJ+ND: p=0.003, and RCGJ+HCHOD: p=0.001). CONCLUSION: Antecolic gastrojejunostomy provided better gastric emptying. An early high-calorie and hyperosmolar enteral diet delayed gastric emptying in both types of anastomosis.

Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study.

AIM: The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented. MATERIAL AND METHODS: Forty patients who were randomized to two groups underwent CIAD or a LIS. The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared. RESULTS: Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications. The post-operative improvement in pain, bleeding, and constipation did not differ significantly between the two groups. In the CIAD and LIS groups, the pre-operative MACRPs were 89.7+/-16.5 and 87.6+/-12.3 mmHg, respectively; 2 months post-operatively, the MACRPs had significantly decreased to 76.9+/-13.7 and 78.1+/-11.3 mmHg in the CIAD and LIS groups, respectively. No statistical difference existed in the pre- or post-treatment MACRPs between the groups. CONCLUSION: CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS. Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety. In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.

Laparostomy in patients with severe secondary peritonitis.

BACKGROUND: The aim of this study was to evaluate the effectiveness of laparostomy with the Bogota bag for the management of patients with severe secondary peritonitis and the risk factors for survival. METHODS: Thirty-seven patients (22 males, 15 females; mean age 63.5; range 44 to 83 years) with secondary peritonitis were treated by laparostomy and temporary closure with Bogota bag. APACHE II scores and Mannheim Peritonitis Index (MPI) were used to calculate the disease severity. The outcomes and effectiveness of APACHE II and MPI values were analyzed retrospectively. RESULTS: The mortality rate was 43.2%. Significant differences were noted between survivors and non-survivors according to initial APACHE II and MPI scores and the number of operations. The non-survivors had higher APACHE II (r=0.81, p=0.001) and MPI (r=0.39, p=0.02) scores. The patients who survived were re-operated 1.6 times and those who died were re-operated 4.7 times. In five patients, laparostomy was closed primarily, while in the others, the wound was left open to heal secondarily. CONCLUSION: Patients with higher APACHE II and MPI scores and number of operations had higher rates of mortality due to their major risk factors. Temporary abdominal closure using the Bogota bag in patients with secondary peritonitis is an inexpensive-simple method, permitting evaluation of underlying viscera and recognition of infection.

The prevalence of Helicobacter pylori and related factors among university students in Turkey.

The frequency and risk factors for contamination of Helicobacter pylori infection was investigated among Sakarya University students. Two-hundred students randomly chosen from among those who volunteered for the study and met its criteria were included. Data were obtained by a questionnaire. H. pylori positivity was checked with the monoclonal H. pylori stool antigen test. Statistical analysis was done with chi-square test. The average age of the subjects was 21.14 +/- 2.06, and 76% of them were female. Monthly family income was below 575 Euros in 69.5% of them, and 56% were living in state dormitories. H. pylori positivity was found to be as high as 63% in our group. According to the qustionnaire (age, gender, blood groups, family income, crowded family living conditions, smoking, alcohol and caffeine consumption, the presence of gastric symptoms, family history, and hygienic behaviors), no statistical differences were found between the H. pylori positive and negative students. These data support the finding that personal and environmental conditions in adults did not affect H. pylori infectivity, and that H. pylori might be acquired in childhood.

[The therapeutic effect of normobaric oxygen in experimental peritonitis and the efficiency of rectal fever, WBC, CRP and procalcitonin in monitoring response of the therapy]. / Normobarik oksijenin deneysel peritonitin tedavisindeki yeri ve tedavinin izlenmesinde rektal ates, lökosit, CRP ve prokalsitoninin etkinligi.

BACKGROUND: It was investigated the effect of using normobaric oxygen (NO) in addition to antibiotherapy in experimental peritonitis and the changes of rectal fever (RF), WBC, CRP and procalcitonin levels were evaluated. METHODS: After the preliminary research of the normal values, rats were infected by E. coli intraperitoneally. Four groups were assigned into "no therapy", "given NO", "given antibiotic", "given antibiotic + NO" groups. RESULTS: The decline of RF and WBC levels on 3rd and 5th days was recorded in antibiotic + NO group versus the other groups. It was observed that group 4 was superior to the others. The positivity of periton cultures and the inflammation in the muscle were found to be less in antibiotic + NO group. No correlation was found between pathological and microbiological recovery and blood CRP level in all groups. But a significant decrease in blood procalcitonin level was determined in group 4 compared to the other groups. On day 3, procalcitonin and CRP levels increased with increasing WBC levels. On day 5, procalcitonin levels also decreased in groups with decreased WBC levels, but no significant correlation was found between CRP and WBC levels. CONCLUSION: It was concluded that using of NO in addition to antibiotherapy could increase the success rate of experimental intraabdominal sepsis therapy and blood procalcitonin and WBC levels could be more beneficial than CRP levels in monitoring of the severity of the sepsis.

Impact of the terrorist bombings of the Hong Kong Shanghai Bank Corporation headquarters and the British Consulate on two hospitals in Istanbul, Turkey, in November 2003.

BACKGROUND: The authors sought to estimate the impact of the terrorist bombings of the Hong Kong Shanghai Banking Corporation headquarters and the British consulate in Istanbul, Turkey, on November 20, 2003, on two nearby hospitals, in terms of epidemiologic outcomes, resource utilization, and time course of emergency needs. METHODS: The authors used data from hospital records of injured survivors who used the emergency departments (EDs) at the Taksim Education and Research State Hospital (TERSH) and the American Hospital (AH) in Istanbul on November 20, 2003, to determine the totals and rates of mortality (early, late, and critical), injury, critical injury (Injury Severity Score > 15), ED use, hospitalization, operative care, and in-hospital overtriage and the time intervals of ED arrival. RESULTS: The TERSH received 184 victims in the first hour after the initial blast, of which 88 (48%) were brought by emergency medical services, 171 (93%) had lacerations, 7 (4%) had penetrating eye injuries, 28 (15%) were hospitalized, 18 (10%) received operative care, and 7 (4%) were critically injured. Three deaths occurred in critically injured survivors, including one early death in the operating room and two late deaths on days 5 and 6. The AH received 16 victims, of which 14 (88%) had lacerations, 3 (19%) were hospitalized, 2 (13%) received operative care, and 1 (6%) was critically injured. An additional 4 victims were transferred to the AH from other hospitals, of which 3 were hospitalized and none were critically injured. No early or late deaths occurred. CONCLUSION: Mortality, injury, and hospitalization rates at both hospitals were consistent with previous reports of open-air mass-casualty terrorist bombings. The TERSH experienced an unprecedented demand for ED surge capacity in an open-air bombing.

Impact of the terrorist bombings of the Neve Shalom and Beth Israel Synagogues on a hospital in Istanbul, Turkey.

OBJECTIVES: The authors sought to estimate the impact of the open-air mass-casualty terrorist bombings of the Neve Shalom and Beth Israel Synagogues in Istanbul, Turkey, on November 15, 2003, on the American Hospital (AH) in terms of resource utilization, epidemiologic outcomes, and time course of emergency needs. METHODS: A retrospective descriptive study using data from hospital records of injured survivors who used the emergency department at AH on November 15, 2003, to determine the number and percentage of injured survivors who were hospitalized, received operative care, had specific injury types, had an Injury Severity Score >/=16, died, and arrived within certain time intervals. RESULTS: AH received 69 (91%) injured survivors from the scene, of which nine (12%) were hospitalized and three (4%) received operative care. Starting four hours after the initial blast, seven (9%) injured survivors were transferred to AH from other hospitals, of which five (7%) were hospitalized and four (5%) received operative care. Of the 49 injured survivors from the scene with documented injuries, 43 (88%) had injuries to the head or face, 42 (86%) had lacerations, five (10%) had fractures, one (2%) had a penetrating eye injury, one (2%) had a serious intracranial injury, and none had primary blast injuries. Four (5%) injured survivors at AH had an Injury Severity Score >/=16, and none died. CONCLUSIONS: Seventy-six injured survivors used the emergency department at AH, including a delayed wave of injured survivors transferred from other hospitals. The majority of injured survivors with documented injuries had non-life-threatening lacerations of the head or face, and relatively few injured survivors were hospitalized or received operative care.

[Evaluation criteria for selecting patients for surgical or nonoperative treatment in nonvariceal upper gastrointestinal bleeding]. / Varis disi üst gastrointestinal sistem kanamalarinda cerrahi ve konservatif tedavi için hasta seçiminde dikkate alinacak noktalar.

BACKGROUND: We evaluated the patients who underwent surgical or nonoperative treatment for acute nonvariceal upper gastrointestinal bleeding. METHODS: The study included 31 patients (21 males, 10 females; mean age 60 years; range 19 to 82 years) with nonvariceal upper gastrointestinal bleeding. Surgical treatment was performed in 14 patients (10 males, 4 females; mean age 64 years), while 17 patients (11 males, 6 females; mean age 55.6 years) were treated conservatively. The two groups were compared with respect to age, sex, associated diseases, arterial blood pressure, pulse rate, and hematocrit values on admission, number of blood transfusions, endoscopic findings, cause of bleeding, and mortality. RESULTS: Upon admission, all the patients underwent endoscopic examination except for five surgically-treated patients. Peptic ulcer was detected in 74.1% of the bleedings. The incidences of duodenal ulcer and stomach ulcer did not differ between the two groups. No significant differences were found with respect to the causes of bleedings. The mean number of blood transfusions was 4.36 units preoperatively, and 2.29 units in those treated conservatively (p=0.013). The mean systolic (p=0.002) and diastolic pressures (p=0.029), pulse rates (p=0.003), and hematocrit values (p=0.011) obtained on admission differed significantly. Mortality occurred in only one patient (7.1%) due to cardiac failure in the postoperative period. CONCLUSION: Our study yielded elucidative data on the referral of patients to surgical treatment for nonvariceal upper gastrointestinal bleeding.

Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.

BACKGROUND: This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response. METHODS: A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul. RESULTS: On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims. CONCLUSION: The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.

[The comparison of the results of the conservative treatment between isolated solid organ injuries and those injuries associated with extraabdominal injuries after blunt abdominal trauma between isolated solid organ injuries and those injuries associated with extraabdominal injuries after blunt abdominal trauma]. / Künt karin travmasi sonrasi izole abdominal solid organ yaralanmalari olan olgular ile beraberinde ekstraabdominal yaralanmalari da olan olgularin konservatif tedavi sonuçlarinin karsilastirilmasi.

BACKGROUND: To determine whether conservative treatment in blunt abdominal solid organ injuries associated with extraabdominal trauma is safe or not. METHODS: Between December 1998 and December 2001, 49 patients were admitted with blunt abdominal trauma, 34 of whom were hemodynamically stable. These 34 patients were divided into two groups. Seventeen patients had isolated abdominal solid organ injuries (Group I) and 17 patients had associated extraabdominal injuries (Group II). The results of conservative treatment, blood pressure values, pulse rates, ages, gender, abdominal solid organ injury scores, the etiologies of trauma, the number of the blood transfusions, morbidity and mortality rates, and hospital stays were compared. RESULTS: The blood pressure values and pulse rates as measured in our emergency room, abdominal solid organ injury scores, ages, gender, the results of conservative treatment, the etiologies of trauma, morbidity and mortality rates were similar in both groups. Comparisons between hospital stays and numbers of the blood transfusion have show statistically significant differences in favour of group II. No patients had hollow viscus injury. CONCLUSION: Conservative treatment is safe for hemodynamically stable blunt abdominal trauma patients with solid organ injury but no hollow viscus injury, even if they have extraabdominal injuries. The existence of extraabdominal injuries, however, prolongs the hospital stay and increases the need of the blood transfusion.

[Selective approach to the penetrating stab wounds to the abdomen]. / KARINA PENETRE KESICI DELICI ALET YARALANMALARINDA KONSERVATIF TEDAVI.

BACKGROUND: To present the results of the selective treatment on the penetrating stab wound to the abdomen METHODS: From December 1997 to February 200, 175 patients had penetrating stab wound injuries to the abdomen. Of the 175 patients, 61 (34.9%) in Group I were taken to the operating room urgently, 114 (65.1%) in Group 11 were treated selectively. RESULTS: It is evident that the rate of unnecessary laparotomies (X2=6.7, p=0.03), morbidity rate (X2=15.4, p

[Bouveret'S syndrome: gastric outlet obstruction by a gallstone]. / BOUVERET SENDROMU: SAFRA TASINA BAGLI MIDE CIKIS OBSTRUKSIYONU.

This rare syndrome first described by Bouveret in 1896, occurs when a stone migrates through a cholecysto or choledochoduodenal jistula lodging in the duodenal bulb and resulting in obstruction. Up to date, less than 100 cases reported in the literature. This rare type of gallstone ileus can be diagnosed and treated endoscopically, although there are a few previous reports of successful endoscopic, removal. However, surgical removal is safe and effective but the most controversial aspect is the proper treatment, simple enterotomy and removal ofthe gallstone alone or enterolithotomy in association with cholecystectomy and dejinitive correction ofthe biliodigestive fistula. This paper presents a case report of a 65 year old man with gastric outlet obstruction caused by a large gallstone. The diagnose and treatment of this case who was admitted in 1.General Surgical Department of Taksim Teaching and Research Hospital was researched under the reference of recent literature.