Turkish Journal of Surgery - 2009; 25(4) - Current Issue

Heat shock proteins

Ersin �zt�rk, Nevzat Kahveci, Kas�m �zl�k, Tuncay Y�lmazlar — 2009-10-01

Heat shock proteins (HSP) are a group of proteins that have a molecular weight less than 100 kDa and whose production is induced by heat (42-46�C) shock. Infection, inflammation, some toxins such as ethanol, arsenic, trace metals and ultraviolet light, hunger, hypoxia, lack of nitrogen (in plants) and dehydration are the factors that could induce HSP production. HSPs are classified into four main groups according to their molecular weights; HSP 90 family, HSP 70 family, HSP 60 family and the small HSP family. They have functions mainly in cytoprotection, neurodegenerative pathologies, signal transduction pathways and cancer immunology.

Knowledge and attitudes among first year medical students about organ donation

2009-10-01

Purpose: The aim of this study was to determine the knowledge, attitude and behaviour among first year medical students about organ donation. Materials and Methods: The research population was the 143 students in the first year at Erciyes University Medical School and 72.0% of the students (n=103) completed the survey. The research data were collected with a questionnaire prepared by the researchers. Number, percentage calculation, and chi-square test were used in the data analysis. Results: Out of 103 students 34.0% were wiling to donate their organs, while 15.5% refused and 50.5% were uncertain. Only 2.9% had signed an organ donor card. All of the students were thinking that their knowledge about transplantation is sufficient. Conclusion: The willingness of the students to donate their organs was low and the ones who want to donate has not got a card. In order to enhance the attitude of the students toward organ donation, education programmes in the curriculum must start in the early period.

A different look at the specialist education of general surgery

2009-10-01

Aim: We planned a trial to establish the realities on the suggestion which included the idea that there is loss of interest to General Surgery residency or it is not among the top choices. Material and Method: We performed a questionairre on 202 residents who studied general surgery residency in 9 state universities in Ankara, Istanbul, Izmir and Bursa. The residents were asked about which medical school they have graduated from, how many times they joined residency examination, in which examination they succeede to start residency and the order of their choice of general surgery residency was in their list. Results: Among those 202 residents, only 40 of them preferred general surgery residency as the first choice in their list (19.8 %). Most of residents who were successful in the first examination period preferred Ankara University General Surgery Department (44.4%). The residents who preferred general surgery residency as the first choice were found mostly in Hacettepe University General Surgery Department (37.5 %). Most residents who preferred general surgery residency in their first 3 choice in their list were found in Uludag University General Surgery Department (64.3 %). Examination for medical doctor residency April 2009 results have shown that general surgery residency was chosen in the 24th level among 25 branches. Conclusion: As a result general surgery residency was found to be placed at the end of the choices in residency examination among other branches in our trial.

N-acetylcysteine can attenuate liver injury in obstructive jaundice in rats

H.Hakan Mersin, Murat Akbaba, Emel Ba�kan, U�ur Berbero�lu — 2009-10-01

Purpose: To investigate the effect of N-acetylcysteine (NAC) on the level of tumor necrosis factor-a (TNF-α) and liver parenchyma injury in an experimental rat model of obstructive jaundice. Patients and Methods: Thirty-six Wistar-Albino rats weighing 250- 300 g were randomly divided into three groups of 12 animals in each, as sham-operated, bile duct ligated plus NAC-treated (treatment), bile duct ligated plus saline administered (control). After the operation, the rats in treatment and control groups were administered NAC and saline, respectively. After 10 days of treatment, liver function tests were performed and plasma TNF-a levels were determined in all rats to assess the parenchymal damage. Results: Parenchymal damage and plasma TNF-α levels were significantly lower in the treatment group, compared with the control group. Conclusion: NAC can be useful in decreasing the paranchymal damage in the liver and suppress the plasma TNF-α levels in experimental obstructive jaundice.

Comparing the results of laparoscopic adrenalectomy with open adrenalectomy

Mustafa Taner Bostanc�, Mehmet G�rg�n, Muharrem Karao�lan, Hidayet �atal — 2009-10-01

Aims: In this study, our purpose is to compare the results of the patients we carried out laparoscopic adrenalectomy because of the adrenal mass with the patients carried out open adrenalectomy in the same period and to present these results. Material and method: Laparoscopic lateral transperitoneal adrenalectomy was carried out to a total of 19 patients in our hospital. In 18 of these patients, laparoscopy was performed successfully while in one patient conversion to open surgery was required. The control group of open adrenalectomy which consisted of 18 patients was gathered retrospectively starting with a case operated in 2006, using sequential patient selection. The case for whom conversion to open surgery was required, was excluded from the study. Parameters of the age, sex, the nature of adrenal disease, the affected side, the size of the adenal tumor, the weight of the adrenal tumor, were investigated. Mean operating time, hospital stay, early complications were compared between the groups. Results: 18 patients were treated by laparoscopic adrenalectomy successfully, in one patient however, conversion to open operation was required (%5,2 ;1/19). There was no significant difference between the demographic details of the two groups. There was no difference between the groups in terms of tumor size, tumor weight, affected site, mean operating time, early postoperative complications. However, mean duration of postoperative hospital stay for patients undergoing laparoscopic adrenalectomy was shorter and patients in laparoscopy group had less blood loss, which were statistically significant. Conclusion: Laparoscopic surgery in the appropriate patient is safe and efficient. Laparoscopic surgery should be the procedure of choice especially for the benign lesions . Surgeons carrying out laparoscopic adrenalectomy should be adequately trained and comfortable with performing both adrenal surgery and laparoscopic surgery.

Surgical treatment of nodular goiter and incidental malignancy rates

Selim S�zen, ��kr� D�lalan, H�seyin �zg�r Ayta�, Hasan Elkan — 2009-10-01

Purpose: In this study we aimed to present our incidental malignancy rates in patients who were operated due to goiter. Patients and Methods: The records of 114 patients who underwent surgery due to goiter between the years 2008–2009 were examined, retrospectively. Of the patients, 96 were women (84.21%), and 18 were men (15.78%).The mean age was 44.72�11.32 years. Results: Postoperative histopathological examination results were malignant in 16 patients (14.03%); 12 (75%) of these were papillary carcinoma, 3 (18.75%) were follicular carcinoma and 1 (6.25%) was medullary carcinoma. The overall malignancy rate was 14.03%. Conclusion: We think that malignancy rates will increase, as the experience of cytologists increases. In conclusion, more extended surgical resections should be preferred by the surgeon for the treatment of benign nodular goiter.

A rare complication of laparoscopic adjustable gastric banding procedure: Opening of band (horseshoe view)

2009-10-01

Purpose: In the present study, the reasons for band release, a rarely encountered complication, as well as the ways to prevent opening of band, were determined in patients who had undergone laparoscopic adjustable gastric band (LAGB) surgery. Materials and Methods: LAGB was performed for suitable patients. The patients were re-evaluated at each visit. Patients who were thought not to have lost an adequate amount of weight had a barium contrast gastroduodenal radiograph and/or direct radiograph following administration of an opaque substance through the port. Friedman test was used to evaluate the percentage of excess weight loss (EWL) and the percentage of recovery (PCV). Results: LAGB surgery was performed in 101 cases using the pars flaccida technique. 94 patients were included in the study. The mean age of the patients was 27 years (range, 18-55 years), and the mean follow-up period was 23 months (range, 2-31 months). BMI was 44 kg/m2 (37-62 kg/m2), EWL was 52.6% (p<0.05), and PRC was 52.3% (p<0.05). Opening of band occurred in 4 patients. Three of the 4 patients underwent a Roux-en-Y gastroenterostomy (RYGE) procedure, whereas, the band of 1 patient was relocked. Conclusion: LAGB is an effective and safe surgical technique in the treatment of obesity. However, the efficacy of the treatment is influenced by technical problems, such as opening of band. Opening of band can be easily diagnosed on the opaque radiographs. When this event occurs, the band should be relocked or a malabsorptive procedure should be performed.

Effects of topical nicotinamide and acetyl cysteine in chronic wound healing model

2009-10-01

Purpose: Wound healing is a well-organized reparation process that develops after an operation or trauma. Healing process can be disturbed due to various factors. Decreased blood supply and subsequent hypoxia are some main factors. This interrupted process can frequently happen during diabetes and, decubitus and venous ulcers. In this study we aimed to observe the effects of nicotinamide and acetyl cysteine over chronic wound healing in topical applications. Patients and Methods: Forty five Sprague-Dawley male rats are used in this study. Control, acetyl cysteine and nicotinamid groups are divided into three sub groups, as wound tissues to be obtained in 3rd, 5th and 8th days. A 6 mm punch biopsy was performed under anesthesia, to create a total of 6 excisional skin wounds on the bipedicular flaps at the dorsal side of each animal. On these ischemic skin wounds 50 mg/kg acetyl cysteine and 100 mg/kg nicotinamide was applied b.i.d. for 7 days. At 3rd, 5th and 8th days, the degree of healing was assessed by wounds' surface area measurements and histopathological evaluation. Results: In the histopathological assessments performed in 3rd, 5th and 8th days, it is found that the groups in which nicotinamide and acetyl cysteine were applied had less inflammatory cell numbers but more fibroblasts and collagen synthesis, in comparison to the control groups. Similar to the histopathological findings, a significant decrease was observed in the wounds' surface areas measured on a daily basis. Conclusion: We demonstrated in this study that nicotinamide and acetyl cysteine molecules which are known to be effective antioxidants affect the chronic wound model positively and accelerate the recovery process.

Minithoracotomy approach to hydatid cysts localized at the diaphragmatic surface

�mer Faik Ersoy, Nam�k �zkan, Ali Yeginsu, H�seyin Ayhan Kayao�lu, Alper �elik — 2009-10-01

Hydatid cyst is a common and important health problem that is frequently caused by a parasite named echinococcus granulosus. The incidence of the disease is 4,9/100.000 per year in our country. Surgery is the main choice of therapy. Classical approach via transabdominal route is difficult in cases where the disease is localized at the diaphragmatic surface. The alternative approach is the transthoracic way. Here we present the results of 3 cases operated by minithoracotomy for their diseases localized at the diaphragmatic surface.

Report of a case: M�n�trier disease with severe hypoproteinemia and its surgical treatment

B�nyamin G�rbulak, Esin Kabul, Emre Bal�k, Yasemin �zl�k — 2009-10-01

M�n�trier's disease is an uncommon condition of unknown aetiology. It is characterized with giant hypertrophic mucosal folds of the stomach and associated with loss of protein from the mucosa. There is no enough data about genetic predisposition of M�n�trier disease. However, some paper regarding to familial occurence have been reported. We reported a case of M�n�trier disease with malnutrition and severe hypoproteinemia despite of treatment, its surgical treatment, and his sibling suggesting the possibility of genetic occurence for this condition. A male with a diagnosis of M�n�trier disease with severe hypoproteinemia was operated. Patient overcame some complications such as nasocomial pneumonia, hypoxic ischemic encephalopathy resulted in left monoparesis. He discharged from hospital after thirty days postoperatively. His son complaining some dispeptic symptoms performed gastroscopy and biopsises was diagnosed of mild hypertrophic gastritis, and is following for possibility of familial M�n�trier disease by periodical gastroscopy and biopsies. The risk of malignancy in M�n�trier disease is still controversial. However, total gastrectomy is still the most definitive treatment for M�n�trier's disease, especially for patients with uncontrollable severe protein loss.

Retroperitoneal extraadrenal giant paraganglioma: A case report

L�tfi Soylu, Sezai Ayd�n, Mehmet Alper Salman, Fuat Atalay — 2009-10-01

Retroperitoneal paragangliomas are rare tumors.They usually present abdominal pain and mass clinically. A literature review suggests that only a few cases have been reported so far. A case of giant retroperitoneal paraganglioma 20x30 cm in size with extraadrenal origin in a 66-year-old patient is reported alongside with its clinical presentation, diagnosis, surgical management and literature review.

From 1^st Surgical Clinic (1. Seririyat-i Hariciye) to Istanbul University Cerrahpasa Medical Faculty Department of General Surgery: Celebration of 100^th Year of Foundation (1909-2009)

Ertu�rul G�ksoy — 2009-10-01

The story of the clinic began in 1909 with the chairperson Prof. Dr. Cemil Topuzlu as 1st Surgical Clinic (1. Seririyat-i Hariciye) and continued with Prof. Dr. Kerim Sebati at the same place. In 1933, subsequent to so-called “University Reform” the clinic was moved to Cerrahpasa Hospital and chaired by Ord. Prof. Dr. Rudolf Nissen from Germany, with the name “Istanbul University Medical Faculty the 1st Surgical Clinic” until 1940. The department was then directed by Prof. Dr. Burhaneddin Toker between 1940 and 1951. The clinic was transferred into a new building and the directors paid attention to specialization in surgery. In 1951, a new organization was made and 1st Surgery Clinic (chair: Prof. Dr. Kaz�m �smail G�rkan) and 2nd Surgery Clinic (chair: Prof. Dr. Fahri Arel) were established. These two separate clinics were re-united again in 1963. The clinic was named as ”Cerrahpasa Department of Surgery” between 1963 and 1967, and since Cerrahpasa Medical Faculty was founded in 1967, it was named as the Department of Surgery in this new faculty. Thereafter, the department was chaired by Prof. Dr. Fahri Arel (1963 - 1972) and Prof. Dr. Adnan Salepcioglu (1972-1982). According to the new laws established in 1982, the Department had a new name in Turkish (Genel Cerrahi Anabilim Dal�) which was defining General Surgery as a “main scientific branch”. The following directors of the department were Prof. Dr. Kemal Alemdaroglu (1982-1983) and Prof. Dr. Selcuk Aybar (1983-1990). The clinic was moved to its current location in 1988. Afterwards, the department was chaired by Prof. Dr. H�rol Insel (1990 – 1999) and Prof. Dr. Umit Balc�soy (1999 – 2007) Prof. Dr. Ertugrul G�ksoy is the current director of the department since 2007.

Edit�re Mektup

Sezai Demirba� — 2009-10-01

Yazarlar�n Yorumu

Cemil �al��kan, Erhan Akg�n, Mustafa A. Korkut — 2009-10-01

Edit�re Mektup

�. Ethem Ge�im — 2009-10-01

Turkish Journal of Surgery - 2009; 25(4) - Current Issue

Heat shock proteins

Knowledge and attitudes among first year medical students about organ donation

A different look at the specialist education of general surgery

N-acetylcysteine can attenuate liver injury in obstructive jaundice in rats

Comparing the results of laparoscopic adrenalectomy with open adrenalectomy

Surgical treatment of nodular goiter and incidental malignancy rates

A rare complication of laparoscopic adjustable gastric banding procedure: Opening of band (horseshoe view)

Effects of topical nicotinamide and acetyl cysteine in chronic wound healing model

Minithoracotomy approach to hydatid cysts localized at the diaphragmatic surface

Report of a case: M�n�trier disease with severe hypoproteinemia and its surgical treatment

Retroperitoneal extraadrenal giant paraganglioma: A case report

From 1st Surgical Clinic (1. Seririyat-i Hariciye) to Istanbul University Cerrahpasa Medical Faculty Department of General Surgery: Celebration of 100th Year of Foundation (1909-2009)

Edit�re Mektup

Yazarlar�n Yorumu

Edit�re Mektup

From 1^st Surgical Clinic (1. Seririyat-i Hariciye) to Istanbul University Cerrahpasa Medical Faculty Department of General Surgery: Celebration of 100^th Year of Foundation (1909-2009)