Turkish Journal of Surgery - 2000; 16(5)

WHERE DOES SURGERY STAND WITHIN THE NETWORK OF CYBERWORLD: THE IMPORTANCE OF INTERNET FOR SURGEONS

AF�AR BARLAS, ALP OL�VER F�RDERER, BAHADIR M G�LL�O�LU — 2000-10-01

TUMOR ANGIOGENESIS

M�NE G G�LL�O�LU, FERHUNDE D�ZDARO�LU — 2000-10-01

Angiogenesis, or neovascularization, is the formation of new capillaries from preexisting blood vessels. It is a normal mechanism in many physiological events as well as in wound healing. It is known that it is a key for the tumor progression. A tumor begins to produce new vessels when the balance between the angiogenic and antiangiogenic factors changes, and it gains the capacity of growth, invasion and metastasis. The tumor angiogenesis is the subject of research for new anticancer therapy agents because of its relation to tumor progression. The results of these research are quite promising, in this pathobiology centered review, the tumor angiogenesis is summarized with its mechanisms of development and the factors responsible for the angiogenic events

THE EFFECTS OF MELATONIN ON ANGIOGENESIS AND WOUND HEALING

�ZG�R ODABA�, G�RSEL SOYB�R, AYHAN B�L�R, HALUK KARDA�, CEMALETT�N TOPUZLU — 2000-10-01

The effects on angiogenesis of melatonin hormone were researched in wound healing process in the experimental study model, using 30 Wistar Albino rats. Although wound healing is not a well-known process, cells of immune system increase releasing of factors which are effective in the process. Whereas it is known that melatonin particularly induces productions of IL-1, TNF-alfa and TGF-beta. Immunomodulator effect of melatonin is unclear at the proliferation phase of wound healing. Rats were divided into two equal groups. Before and after the incisions made on the back skin, 0,9% NaCl at the dose of 0.25 cc/rat/d was injected to group l, and melatonin dissolved in 0,9% NaCl at the dose of 0,4 mg/kg/d was injected to group 2 via intramusculer route, The phases of healing were assessed as compared with the control group, At 3,7,10,14 and 21 days of the study, excisionel biopsies were made from the healing tissues, and were investigated for angiogenesis criterions under light and electron microscopes. Hydroxyprolin levels were also measured in the tissues. Unlike in control group, it was seen that neovascularization began in every stages of light and electron microscopic examinations and that there was a significant increase in the number of new vessels (p<0.05). in all stages, particularly at 10, 14 and 21 days, melatonin group showed better developing than control group in measurement of the tissue hydroxyprolin levels. Melatonin may have positive effects on angiogenesis and wound healing, and the results were encouraging new studies.

THE EFFECT OF ENTERAL IMMUNNUTRITION ON EXPERIMENTAL WOUND HEALING

YAVUZ KAYA, OSMAN YURTTA� — 2000-10-01

It has been reported that immunnutrition decreases postoperative complications. However, there are limited data about the effect of immunnutrition on wound healing, in this study, we aimed to find out the effect of enteral immunnutrition on wound healing, which is a metabolic and immunologic process. Sixty Wistar Albino rats were divided into 3 groups following simple laparotomy and primary closure: Rats were fed standard laboratory chow in group l (control group); standard enteral nutrition solution (Osmolite(r)-Abbot,USA) in group 2 (SEN); enteral immunnutrition solution, which contains arginine and nucleotide and omega-3 fatty acids, (lmpact(r)-Novartis,UK) in group 3 (EIN). The rats in each group were further randomly divided in two subgroups that were sacrificed on postoperative days 7 and 14. Serum albumin and total protein levels, skin hydroxyproline level and wound breaking strength were measured for each animal. Results were compared using one-way analysis of variance (ANOVA) and Student-Newman-Keuls post hoc test. On postoperative day 7; serum albumin levels were higher in E�N group than SEN and control groups (p<0.05). No statistical differences were found among the groups with respect to the other parameters. On postoperative day 14; serum albumin and total protein levels in EIN group, skin hydroxyproline levels in SEN group and wound breaking strength measurements in all groups were higher on postoperative day 14 than day 7 (p<0.05). In EIN group, serum albumin and total protein and skin hydroxyproline levels were higher than those in control group (p<0,05), While wound breaking strength measurements were higher in EIN group than SEN and control groups, there was no statistical difference between SEN and control groups. As a result, higher serum protein and skin hydroxyproline levels and wound breaking strength were obtained in the rats with enteral immunnutrition than with rat chow or standard enteral nutrition.

RESIDUAL TISSUE ASSESSMENT AFTER THYROID SURGERY

2000-10-01

Residual tissue is important for ablation therapy in patients who have hyper thyroidism, and in patients who have well differentiated thyroid cancer whose diagnosis is performed after surgery. It is difficult to assess the volume of residual tissue. To determine residual tissue after thyroid surgery, tissue samples were obtained from 81 patients who underwent thyroid surgery for nodular colloidall goiter between January 1999 and December 1999 at Department of Genereal Surgery, Atat�rk University, Faculty of Medicine. Dimensions of 5-gr tissue samples were found to be 2.5 x 1.5 x lcm and dimensions of 10-gr tissue samples were found to be 3.5 x 2.5 x lcm. After thyroid surgery dimensions must be 2.5 x l .5 x l cm for 5gr and 3.5 x 2.5 x lcm for 10 gr residual tissue.

LAPAROSCOPIC CHOLECYSTECTOMY WITH MINI INSTRUMENTS (MINISITE CHOLECYSTECTOMY)

AHMET ALPONAT, ANIL �UBUK�U, NE�ET NUR� G�N�LL�, ZAFER CANT�RK, O�UZ �ZBAY — 2000-10-01

The advantages and technical details of minisite cholecystectomy (MC) were investigated in this study. The rapid development in the endoscopic industry has recently introduced 2 mm delicate instrument into the laparoscopic field. The main objectives were to have smaller incision, better cosmetic result, less trauma, therefore lower morbidity rote. Twenty two consecutive patients who were admitted for elective laparoscopic Cholecystectomy (LC) were introduced into the study. Following the evaluation of presence of adhesions around the gallb laddder of the beginning of the operation, 18 patients were considered suitable for MC, Operation was successfully completed in 15 patients and conversion to standard LC was required in 3 patients due to bleeding (in 2 cases) and difficulty in defining anatomy (in one case). The mean age was 46. l years (range 23 - 78) and female/male ratio was 13/2. The average operating time was 79.4 minutes (range 45-110). Technique was performed using four punctures with one 10 mm port in the umbilicus and three 2 mm port as in the same position with standard laparoscopic Cholecystectomy (in the right subcostal region). The retraction of the fundus and dissection on hepatoduodenal ligament was performed using mini graspers and miniscissors. Clips were applied to the cystic duct and artery through the umbilical port after changing the 10 mm telescope to 2 mm telescope which was introduced via epigastric port. Gallbladder was delivered from the umbilical port under the direct vision of 2mm scope, All patients were ambulatory 6 hours after the operation. All were discharged at 24 hours. Postoperative analgesic requirement was not different from those who underwent standart LC. At the evaluation of the scar tissue 3 months after the operation 2 mm port sites were barely visible and all patients scored their scar tissue as excellent.