Turkish Journal of Surgery - 2005; 21(1)

Hekimlikte d�nden bug�ne

Ahmet Yayc�o�lu — 2005-01-01

Protective effect of sulfasalazine on the intestinal ischemia-reperfusion injury

2005-01-01

Purpose: Acute mesenteric occlusion is a serious clinical entity which usually requires prompt surgical intervention. Although reperfusion is mandatory for the repair, the release of free oxygen radicals and the induction of neutrophyl accumulation attenuates the injury. NFkappa B has a critical role in inflammatory process. This study is based on the hypothesis that sulfasalazine, a potent inhibitor of NF-kappa B may counteract or decrease the ischemia/reperfusion (I/R) injury in rats. Materials and Methods: The study consisted of three groups each containing 10 rats. In the control group (Group I) superior mesenteric artery was dissected, but not ligated. Two hours later tissue samples from ileum and blood samples from portal vein were taken and the rats were sacrificed. In I/R group (Group II) after dissection of superior mesenteric artery, it was clamped just distal to the origin from aorta. Clamp is released after 1 hour ischemia and tissues were reperfused. The same samples as in control group were taken. In sulfasalazin group (Group III), apart from group II, 30 minutes after the beginning of the ischemia, sulfasalazine was given. The tissue samples from ileum were stained for iNOS, p65 and caspase immunohistochemically. NO level was determined in blood samples by Greiss reaction. iNOS, p65 and caspase protein expressions in tissue sections and NO levels in serum were at the basal level in control group. Results: In I/R group both protein expressions and serum NO levels were very high. However in sulfasalazine group, these parameter levels were found higher than control group, but less than the levels found in I/R group. Statistical analysis showed that although there was significant difference between control group and I/R group (p<0.05) with regard to serum NO levels, iNOS and caspase expressions, sulfasalazin group has no significant difference when compared with control group (p>0.05). p65 expression was found to be significantly increased in I/R group compared to control group (p<0.05), whereas in sulfasalazine given group the expression decreased compared to I/R group. However, the decrement was not statistically significant. Conclusion: This study demonstrated that sulfasalazin may have protective effect on experimental rat intestinal ischemia-reperfusion injury through down-regulation of tissue proteins responsible from celluler damage.

Effect of peritoneal lavage with chlorhexidine gluconate solution on survival and adhesion formation

�mer Top�u, Mustafa Duman, Ayhan Koyuncu, Cengiz Ayd�n, Mustafa Turan, Metin �en — 2005-01-01

Purpose: In this experimental study; effects of chlorhexidine glucunate solution on peritoneal adhesion formation and perioperative mortality were investigated. Peritoneal Hydatidosis (PH) still remains the most important complication of hydatid cyst surgery. Peritoneal lavage with scolocidal agents and chemotherapy are suggested as a therapeutic approach in the peritoneal dissemination. Materials and Methods: Eighty male rats were divided into four equal groups. Group 1: 0.9% NaCl ( Control), Group 2: 20% NaCl, Group 3: 0.4% Chlorhexidine Glucunate (Chx-Glu), and Grup 4: 0.04% Chx-Glu. Two ml solution in each group was instilled into the peritoneal cavity through a median laparotomy and aspirated 5 minutes later. Animals that survived the perioperative period were sacrificed at the fifteenth postoperative day. Adhesion formation were macroscopically graded by Nair criteria. Results: Mortality rate was not significantly different between groups (p>0.05). Adhesion formation was significantly low in study groups compared to control group (p<0.05). Adhesion formation was significantly low in Chx- Glu groups compared to 20% NaCl group (p<0.05). There was no diffirence of adhesion formation between Chx-Glu groups (p>0.05). Conclusion: Currently, intraabdominal adhesions are still important problems in the surgical area. We recommend the use of 0.04% Chx-Glu solution in the treatment of hydatid disease and Peritoneal Hydatidosis as a potent and non-toxic agent in addition to its ability for decreasing intrabdominal adhesion formation.

The effects of N-acetylcysteine on bacterial translocation and liver and ileum structure in a rat model of obstructive jaundice

2005-01-01

Purpose: In this study the effects of N-Acetylcysteine (NAC) on bacterial translocation, and ileum and liver structures were investigated in a rat model of obstructive jaundice. Materials and Methods: Twenty four wistar albino rats were randomly allocated in four groups. Group I (Control Group), Group II (Sham Group), Group III (Obstructive Jaundice Group), Group IV (Treatment Group) (50 µmol/kg/day NAC i.m.). Rats were sacrificed on day ten. Serum total/direct biluribine, AST,ALT,ALP and GGT levels were measured. Laparotomy was performed and mesenteric lymph node, liver, spleen specimens and caecal cultures were collected for the evaluation of bacterial translocation. Liver biopsies and terminal ileal segments were collected for histopathological evaluation. Results: Statistically significant differences were detected between the treatment group and other groups in terms of total and direct biluribine, AST and GGT levels(p<0.05), There were some differences in terms of bacterial translocation between the groups, but these changes were not statistically significant(p>0.05). No bacterial translocation could be detected in the liver and spleen specimens of the treatment group although 50 per cent of mesenteric lymph node specimens showed bacterial translocation. Hepatic structural changes were partially minimised in the treatment group although this was also statistically in significant( p>0.05). Conclusion: These findings showed that, antioxidant, cytoprotective and microcirculatory effects of NAC could lower bacterial translocation rates and minimise the histological changes of liver and ileum of jaundiced rats. These changes could lower the perioperative morbidity and mortality.

The analysis of our patients with biliary injuries

2005-01-01

Purpose: The aim of this study is to review risk factors, prevention, management and timing of surgery, presentation, investigation and principles of treatment for biliary injuries and strictures with retrospective examination of our cases. Background: Bile duct injuries still continue to be one of the most serious problems in surgical practice. By far iatrogenic strictures following upper abdominal surgery,especially cholecystectomy are the most common problem. Materials and Methods: Eight patients with biliary injury and strictures who were treated between May 1999 and January 2005 in Mersin University Medical School General Surgery department were investigated retrospectively according to age, gender, risk factors, management and timing of surgery, presentation, investigation and principles of treatment, early and long-term outcomes. Results: Biliary injuries in all patients who were treated in our department were occurred during laparoscopic cholecystectomy. 4 patients were diagnosed during the operation, 4 patients were diagnosed in the immediate postoperative period. Roux-En-Y hepaticojejunostomy and closure of the defect with sutures over a T-tube was performed in our patient to repair these injuries. Two patients were died and 6 patients were followed-up for short and long term results. Biliary complications like bile fistula and biliary injury and strictures were not observed in none of these patients in long term follow-up. Conclusion: Bile duct injuries during laparoscopic cholecystectomy continue to be an important clinical entity. Injury rates have decreased; but have not reached open cholecystectomy levels. Most injuries in our study are diagnosed intraoperatively or early postoperatively, and with management the long term results are acceptable.

Surgical treatment of patients with phylloides tumor of the breast

G�rhan Sakman, Cem Kaan Parsak, Ahmet Aslan, Alper Ak�no�lu, — 2005-01-01

Purpose: We aim to evaluate the diagnostic diffuculties and the surgical options and results for the phyllodes tumors, which are infrequent pathologies of breast tumors. Background: The most recognised clinical problems seen in phyllodes tumors are preopreatively differential diagnosis and postoperatively freqeunt local recurrences. The recommented management option is resection of tumor within at least 2 cm of surgical margin. Recurrence rate is reported as 15-25% in various studies. Materials and Methods: We evaluate the surgical procedures and results of 10 patients with phyllodes tumor retrospectively who admitted to General Surgery Department, School of Medicine, Cukurova University between 1997-2003. Physical examination, breast ultrasonography and mammography were used for preoperative diagnosis. Fine needle aspiration biopsy (FNA), incisional biopsy (IB), and frozen section were used for histopathological diagnosis. Four different surgical procedures were preferred for surgical treatment: 1) Wide mass excision with 2 cm of surgical margin, 2) Simple mastectomy, 3) Simple mastectomy with palpitated lymph node biopsy and 4) Modified radical mastectomy (MRM). Phyllodes tumors should be taken in account in patients with breast mass and with possible diagnosis of fibroadenoma. Differential diagnosis of phyllodes tumor is really upmost importance as the surgical management performed in one seans. Preoperative FNA and core biopsy performed routinely may have an important role as the clinical experience increase. Local recurrence is an important clinical problem in phyllodes tumors. Conclusion: Clinical and radiological evaluations are usually insufficient in the differential diagnosis of fibroadenoma and phyllodes tumours. Evaluation of lesions with frozen section in patients with phyllodes tumours may reduce the possiblity of recurrent surgical procedures. Clinically palpitated axillar lymph nodes in paitents with phyllodes tumors may not be important pathologically. Local recurrence of borderline phyllodes tumors underwent simple mastectomy for maintaining the proposed surgical margin may point out that prognostic criteria might be multi factorial.

The impact of wound management on postoperative wound infection in perforated appendicitis

Bar�� Z�lfikaro�lu, Necdet �zalp, Mehmet Ke�kek, �smail Bilgi�, Mahmut Ko� — 2005-01-01

Purpose: Appendectomy is still most commonly performed emergency surgical procedure. Infection of the operative incision is the most common cause of morbidity after appendectomy for complicated acute appendicitis. Background: Open wound management after complicated (gangrenous or perforated) acute appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Medical records of 445 patients with a median age of 32 years (range 11-85) who had complicated appendicitis between 1997-2003 were evaluated retrospectively. The patients were subgrouped according to type of wound management. Patients in pimary closure and delayed closure subgroups were compared for age, gender, white blood cell count (WBC) on admission, American Society of Anesthesiologist class, APACHE II score, duration of operation, pathological diagnosis, length of hospital stay, the rate of wound infection and mortality. Results: Overall 64.9 % of the surgical wounds was closed primarily and 35.1 % was left open at the end of operation. There was no difference in terms of WBC count, duration of operation, length of hospital, and rate of wound infection between the groups. Conclusion: Based on the study results, we think that primary wound closure in perforated appendicitis is a safe and favourable wound management method.

Our experiences in RF - assisted resections in liver tumors and hydatid cysts

Mustafa �ahin, Adil Kartal, Ahmet Tekin, Ceyhun Pekin — 2005-01-01

Purpose: In this preliminary study, we applied Radiofrequency(RF) energy in six patients with liver diseases for parenchymal transection to minimize bleeding or to do bloodless hepatectomy. Materials and Methods: Of six patients, four had liver tumors ( 3 heamangyomas, one hepatocellular carcinoma) and two hepatic hydatic cysts. Surgical procedures were RF assisted hepatectomy, enucleation, cystectomy and pericystectomy.

Enucleation of giant hepatic hemangiomas: 14 cases

2005-01-01

Purpose: All patients with a diagnosis of hepatic hemangioma who underwent enucleation between January 2000 and January 2004 were reported. Material and Methods: Demographics, biochemical values, diagnostic studies, lesion characteristics, operative time, blood loss, mortality and morbidity, and outcomes were analyzed. Results: Locations were the right lobe in 10 cases, the left lobe in two and both lobes in two. The size of hemangiomas ranged from eight cm to 13 cm in diameter. There was no mortality, and one morbidity. No recurrence of hemangioma was observed. Conclusion: Although enucleation seems a safe procedure for the treatment of giant liver hemangiomas, and is the preferential technique of the authors, it should always be kept in mind that it is not a simple procedure and blood and blood products may be necessary during the surgery.

A rare disease: Pseudomyxoma peritonei

Oktay Banl�, Y�ld�ran Song�r, Necmettin G�vence, Hasan Altun — 2005-01-01

Pseudomyxoma peritonei (PMP) is a rare condition with inevitable persistence and progression. Although its etiology is controversial, commonest site of the origin is the appendix and the ovary. In this study, our purpose is to discuss PMP and to share our experience. In our clinic, two patients, a male and a female with a diagnosis of PMP were operated. Two patients died because of tumor recurrences. Even though PMP is not considered aggressive biologically and there is not a lymph node metastasis and invasion, it is eventually fatal with recurrences and progression of the disease. Due to rarity and heterogenicity of the condition, the treatment of PMP is subject of discussion.

Prebiotics and probiotics in the modern medical area

�zer �lkg�l — 2005-01-01

Today's global medical area are focused recently on the "prebiotics" and "probiotics". These new terms resemble "fermentable-fibre" and "Lactobacillus" respectively. In the light of historical perspective; fermentable fibers have during history of mankind been an important food ingredient. The food of our ancestors was often stored for weeks and months in the soil and when eaten, contribute large amounts of bacteria to the human digestive tract. It is estimated that our Paleolithic forefathers consumed billions of times more of microbes than we do today. As a consequence of this, did they also have a much more diversified and richer microbial flora. Paleolithic foods, as well as also today�s "primitive" foods eaten by various ethnic groups are based on raw plants and consequently contain large amounts of fermentable fibers. The present global epidemy of chronic diseases could strongly be associated with reduced intake of plants and also microorganisms. As a consequence; nowadays the terms of both "prebiotics" and "probiotics" seem-like to take place an important role in the chronic disease epidemiology.