Turkish Journal of Surgery - 2001; 17(6)

THE EFFECTS OF CHOLECYSTOKININ ANTAGONIST IN EXPERIMENTAL ACUTE PANCREATITIS

ERSAN SEMERC�, ORHAN �ELEN, U�UR BERBERO�LU — 2001-12-01

Aims: The aim of this experimental study was to evaluate effects of cholecystokinin receptor antagonist Lorglumide in an experimental model of acute pancreatitis in rats caused by closed duodenal loop. Background: Several studies suggest that cholecystokinin which is an endocrine hormon plays apermissive or contributory role in acute pancreatitis. Since 1979, several competitive receptor antagonists of the cholecystokinin have been developed and therapeutic potential effects of these agents had been investigated in experimental acute pancreatitis models. Material and Methods: After creation of closed duodenal loop 30 rats were divided into two groups, then the CCK-antagonist Lorglumide at 10 mg/kg or 0.9 % NaCl were given intraperitoneally every 6hours. Five rats in each group were sacrified 6,12,24 hours after the closed duodenal loop creation. Following sacrification serum and pancretic tissue were taken for biochemical and morphological studies and wet weight of pancreas was measured. Results: The increase in serum amylase and lipase concentration after closed duodenal loop creation was significantly reduced by Lorglumide at all time intervals when compared with the NaCl group (p<0.05) Lorglumide ameliorated ruptures of ducts, hemorrhage and fat necrosis (p<0.05). Pancreatic wet weight was not effected by cholecystokinin antagonist (p>0.05). Conclusion: Closed duodenal loop creation causes acute pancreatitis in rats. Cholecystokinin antagonist had beneficial effects in this experimental acute pancreatitis model but is not able to eradicate the pancreatitis in this setting.

IMPORTANCE OF PROCALCITONIN AS A SEPSIS MARKER IN MULTIORGAN DONORS

AL� EM�N AYDIN — 2001-12-01

Blood level of procalcitonin which is a sepsis marker, is used to determine the sepsis level in order to make the differentiation between bacteremia and sepsis in cadaveric donors whose blood cultures are positive and showing clinical and laboratory infections signs in Intensive Care Unit. ProCT levels are measured by immunoluminometric methods and levels below 2ng/ml are considered reliable. As 18organs donated from 8 cases showing infections signs are transplanted, 15/18 of these organs seemed to show normal graft function. 3/18 of these transplanted organs showed graft failure. 2 patients were lost due to graft failure. It is determined that organ transplantation is safe when the donors blood procalcitonin (ProCT) levels are below 2ng/ml, showing normal organ function although bacteremiais present.

EFFICACY OF NIFEDIPINE, GLYCERYL TRINITRATE AND BOTULINUM TOXIN IN TREATMENT OF CHRONIC ANAL FISSURE

2001-12-01

Although the recommended treatments of chronic anal fissure are anal dilatation and lateral internal sphincterotomy, which are successful in 85-90% of patients, these procedures permanently weaken the sphincter, which may be associated with incontinence, infection, and anal deformity. The aim of that study is to investigate the efficacy of alternative treatment methods such as nifedipine, glyceryl Seventy-five consecutive patients who applied to Department of Surgery with the diagnosis of chronic anal fissure between 1998 and 2000 were included in the study. Patients were divided into nifedipine(n=25), glyceryl trinitrate (n=25), and botulinum toxin (n=25) groups in a prospective randomised manner. Oral nifedipine 20mg daily for five days in nifedipine group, topical 0.2% glyceryl trinitrate ointment twice daily for 30 days in glyceryl trinitrate group, and a single injection of 25 unit botulinum toxin to internal anal sphincter in botulinum group were applied. The patient in each group were evaluated for their anal resting and squeeze pressures just before and 30 days after treatment, and for their physical signs and symptoms just before and 15 and 30 days after treatment. The resting anal pressures in all treatment groups were decreased significantly according to pre-treatment results (p<0.05). Patients' signs and symptoms were also diminished or disappeared significantly in all treatment groups. No major complication due to applications was detected. It is concluded that oral nifedipine, topical glyceryl trinitrate, and botulinum toxin injection may be alternative to surgical treatment and may diminish permanent complications due to surgical management.

LAPAROSCOPIC DONOR NEPHRECTOMY

2001-12-01

First laparoscopic live donor nephrectomy was reported in 1995 by Ratner and Kavous. Thus far, some university transplant programs in USA have reported their own experiences in large series. But, still there has been no reported case in our country. Between 30.10.2000 and 15.10.2001 we have done 20consecutive laparoscopic live donor nephrectomies and we first present 17 of them. In 14 cases left and in 3 cases right nephrectomies were done. In 15 out of 17 patients operations were terminated laparoscopically. Two patients had to be opened after the kidney was taken out. Mean operative time was 225 minutes because of major bleeding. Mean follow-up period was 7.8 months, in 1 (%5.9) patient acute rejection and 3 (%17.6) patients acute tubular necrosis was seen. One patient who had ATN had to be reoperated at the first postoperative day for bleeding. This patient returned to hemodialysis program and died in the third postoperative month with cerebral and lung tuberculosis. With the use of minimal invasive laparoscopic technique cosmetic defect was minimal and the postoperative pain control was easier. Open live donor nephrectomy has been proven safe for the donor and the transplanted kidney is usually excellent in quality. Laparoscopic technique raises concerns about both donor safety and the quality of removed organ.

NODULAR GOITRE AND THYROID CARCINOMA IN CHILDREN AND ADOLESCENT AGE GROUP

2001-12-01

Although the prevalence of thyroid nodules in children and adolescent age group are extremely uncommon, the malignancy risk of a nodule is greater than adults in this patient group. The objective of this retrospective study was to evaluate the risk of malignancy in noduler goiter in childhood and adolescent age group in an endemic goiter area. The charts of 45 patients (30 girls and 15 boys) with thyroid pathology that had required surgical treatment in our institution (Akdeniz University Hospital, Departments of General and Pediatric Surgery) from August 1991 to May 2001 were reviewed. Age varied from 8 to 21 (mean 18). All the patients, except three, were euthyroid at diagnosis and in the great majority of cases (68%) the only presenting sign was an asymtomatic neck mass. In total, the incidence of thyroid carcinoma was 33% (15 of 45 thyroidectomy specimens). The incidence of malignancy in patients with solitary hypoactive nodules was 38% and in patients with multinod�ler goiter was 31% (p=0.57). The incidence of surgical complications was 9 % (one permanent-one transient hypoparathyroidism and one permanent-one transient laryngeal nerve injury). The prevalence of malignancy in paediatric and adolescent age group with thyroid nodules is more common than adults and these patients should be observed carefully.

COST-EFFECTIVENESS OF THYROID FUNCTION TESTS IN EVALUATION OF THYROIDECTOMY PATIENTS

SERDAR �ZBA�, AL� DO�AN BOZDA�, D�DEM KOZACI — 2001-12-01

Thyroid function tests are in use to evaluate thyroid dysfunctions in possible pathologies of the gland. During the last five decades, many tests were developed to fulfill this ambition. Currently, serum thyrotropin and anti-microsomal antibody levels are more preferably used. However, in our country, many other parameters were also measured to evaluate the thyroid functions. The aim of this study was to discuss the cost-effectiveness of thyroid function test panel (TT3, TT4, sT3, sT4, TSH) compared to the determination of sTSH blood level alone or sTSH + sT4, in evaluation of thyroid dysfunction in 205patients operated in our clinic between March 1997-September 2000. Their differences regarding the operation indications were also evaluated. Costs of TFT panel were determined as 2.255.000.000 TL, while sTSH alone, and sTSH + sT4 costs were calculated as 369.000.000 TL and 881.500.000 TL, respectively. In conclusion, we suggest that serum sTSH measurements in patients with possible thyroid dysfunction is sufficient and much less expensive. In selected cases, addition of sT4 measurement to sTSH may help to evaluate subclinical patients.