Turkish Journal of Surgery - 2006; 22(3)

Surgical approach to pancreas injury: A 15 years experience

2006-09-01

Purpose: Pancreatic injuries due to trauma are relatively rare. Because of retroperitoneal location of the pancreas, there are difficulties in diagnosis and treatment. Aim of this study is to analyze the treatment outcomes of patients undergoing surgery for pancreatic injuries in our center. Materials and Methods: Between January 1990 and September 2006, medical records of 51 patients who underwent surgical intervention for pancreatic trauma were investigated. Age, sex, type of injury, diagnostic interventions, co-injuries of other organs, surgical approach, hospital stay time, morbidity and mortality rates were evaluated retrospectively. Results: Eleven patients had blunt traumas, 26 stab wounds and 14 gunshot injuries. Co-injuries were seen in 42 patients. In 34 patients, serum amylase levels were initially high. Preoperative ultrasonographic examinations were performed in 47, and computerized tomography in 31 patients. In 19 out of 23 cases that had grade I injuries, external drainage was performed; and for the remaining four distal pancreatectomy and splenectomy were performed. Grade II injury was seen in 10 patients. Seven of them had spleen sparing distal pancreatectomy, and three had distal pancreatectomy and splenectomy. External drainage was performed in two out of nine grade III patients and distal pancreatectomy or subtotal pancreatectomy was performed in seven. There were six grade IV injuries. Three of them had subtotal pancreatectomy and the remaining three had pancreaticoduodenectomy. In all of the three grade V injuries, pancreaticoduodenectomy procedures were performed. Postoperative complication rate was 41.2%. Most frequent ones are athelectasis and pneumonia respectively which were seen in seven patients. Perioperative mortality rate was 13.7%. Conclusion: The choice of surgical intervention in pancreatic injuries, depends on the status of pancreatic duct, parenchymal injury grade, co-injuries and anatomical localisation.

Jejunojejunal intussusception caused by an inflammatory fibroid polyp

�lker Abc�, Tarkan Ergun, Hampar Akkaya, Erdal Karag�lle, G�khan Moray — 2006-09-01

Jejunujejunal intussusception is rarely seen due to inflammatory fibroid polyp and only fourteen cases have been reported in literature. It is very important to use post-processing computerized tomography to demonstrate the cause of intussusception in the preoperative period for management of this condition. In this report we present a jejunojejunal intussusception due to inflammatory fibroid polyp which was revealed by post-processing computerized tomography.

A rare cause of mediastinal and cervical emphysema: Duodenal perforation during endoscopic retrograde cholangiopancreatography

Hayrullah Derici, Ali Do�an Bozda�, Tu�rul Tansu�, Okay Nazl� — 2006-09-01

Duodenum perforation during endoscopic retrograde cholangiopancreatography is a rare but life threatening complication. Pneumoperitoneum with pneumothorax, pneumomediastinum and cervical subcutaneous emphysema after endoscopic retrograde cholangiopancreatography is extremely rare and is limited to a few cases in the literature. A patient in whom a perforation occurred in the retroperitoneal duodenum during endoscopic retrograde cholangiopancreatography and pnemoperitoneum, pneumothorax, pneumomediastinum and cervical emphysema formed afterwards is presented and the literature is reviewed in this study.

Current status in laparoscopic colorectal interventions

Metin Ertem, Bilgi Baca — 2006-09-01

Laparoscopy has gained a wide clinical acceptance in colorectal surgery. Laparoscopic techniques have improved the quality of life (less postoperative pain, early return to daily life, etc) in the postoperative period of colorectal diseases. Laparoscopic colorectal resection is one of the most complex procedures amongst laparoscopic surgical interventions. Although laparoscopic colorectal surgery has been successfully performed in benign and malignant colonic lesions, there are still some contraindications. With improving technology and surgical experience, the difficulties and obstacles due to laparoscopic colorectal surgery will be overcome. This article reviews the current status of the data regarding outcomes with laparoscopic colorectal surgery.

Surgeons who have won the Nobel Prize

Ayd�n Ya�murlu — 2006-09-01

The first Nobel Prize in Physiology or Medicine was awarded in 1901, and its receipt is accepted as highly prestigious. This article reflects upon nine surgeons who have received this important award. They are Emil Theodore Kocher, Allvar Gullstrand, Alexis Carrel, Robert B�r�ny, Frederick Grant Banting, Walter Rudolf Hess, Werner Theodor Otto Forssman, Charles Brenton Huggins, Joseph E. Murray. These men have elevated the discipline of surgery to the peak of the scientific world by winning this desirable honor. With this article their bequest as an inspiring reminder was reviewed and the possible capabilities of surgery in the future were discussed

Memenin fillodes t�m�r�nde cerrahi tedavi; G�rhan Sakman ve ark.'n�n ele�tiriye yan�t�

G�rhan Sakman — 2006-09-01

The effect of melatonin on serum and liver tissue lipid peroxidation in hepatic ischemia reperfusion injury

2006-09-01

Purpose: Hepatic ischemia-reperfusion injury (HIR) is a severe condition which is seen after hepatic resection procedures, hepatic arterial injury and in hepatic graft in living donor transplantation. In this study, our goal was to investigate the effect of melatonin, an INOS inhibitor and antioxidant, on the prevention of lipid peroxidation in blood and liver tissue induced by HIR. Materials and Methods: Three groups were designed for the study. 10 Wistar Albino rats (150–200 g) were used for each group. Group A: Sham, Group B: HIR, Group C: HIR + M. No substance was given to the rats in groups A and B. Ischemia was induced with vascular clampage for 45 minutes. With declampage, reperfusion injury was induced for 30 minutes. Five minutes before reperfusion, melatonin 10mgr/kg was given intraperitoneally to Group C. Forty-five minutes after reperfusion rats were sacrificed and blood and liver tissue samples were taken. Serum and liver tissue myeloperoxidase (MPO), malondialdehyde (MDA), were measured. Histopathological examinations for liver tissue were also performed. Results: Plasma and liver tissue MDA and MPO levels were higher in HIR group. In HIR Group (Group B) necrosis and inflammation was detected in the liver tissue. Application of melatonin decreased blood MDA levels significantly, but did not lead to a significant decrease in the tissue levels. Based on the statistical data we gathered, blood and tissue MPO levels were significantly reduced in the melatonin group (Group C) and liver histopathology was significantly improved in HIR group (Group B). Conclusion: Our study showed that application of an antioxidant in HIR injury, led to blood and lipid peroxidation and improvement in liver functions.

Evaluation of low dose bevacizumab on adhesion formation and vascular endothelial growth factor expression in rats

2006-09-01

Purpose: To investigate the effects of bevacizumab experimentally on adhesion formation and vascular endothelial growth factor (VEGF) expression in rats. Materials and Methods: Rats were divided into three groups as sham, control and study groups, each group including 10 rats. In the sham group only laparotomy was performed. Post laparotomy, in both study and control groups, left lower parietal periton was abraded and serosal defects formed on caecum, ileum and right corn of uterus. Following peritoneal abrasions, we applied bevacizumab solution (1 mg/kg) to the study group intravenously, and the same volume of normal saline to the control group in the same manner. We performed relaparotomy to all groups on the 15th day to score and evaluate the adhesion formation. We also took samples from adhesion areas in all three groups for VEGF staining. Results: Adhesion formation and VEGF staining was significantly higher in the control group than in sham and bevacizumab groups (p<0,05). Adhesion formation difference was not significant however between sham and bevacizumab groups (p=0.165). Conclusion: Bevacizumab decreases the adhesion formation in experimentally adhesion formatted rats. There is a correlation between adhesion severity and VEGF expression.