Turkish Journal of Surgery - 2000; 16(3)

MUCIN GENE EXPRESSION IN COLORECTAL CARCINOMA

BELMA KO�ER, AT�LLA SORAN, �MER CENG�Z — 2000-06-01

METHYLENE BLUE AND CARBOXYMETHYL CELLULOSE-SODIUM HYALURONIC ACID IN THE PREVENTION OF POSTOPERATIVE INTRAPERITONEAL ADHESIONS

2000-06-01

The aim of this study is to assess the preventive effects of methylene blue (MB) and carboxymethyl cellulose-sodium hyaluronic acid (CMC+SHA) in postoperative intraabdominal adhesions in an animal model. No therapeutic method has been completely successful to prevent postoperative intraabdominal adhesions and their complications, Rats were separated into three groups of 10 rats. Under anaesthesia, all rats had a midabdominal laparotomy. A serosal incision of 2cm on caecal serosa and 1x1 cm of peritoneal extirpation including muscle layer lateral to laparotomy incision was made, and defects were repaired using 4/0 silk sutures. in control group only 2ml of normal saline, and in MB group 2ml of MB were administrated intraperitoneally, in CMC+SHA group abdominal content was covered by a film of CMC-t-SHA. Abdominal wound was ciosedin two layers. On the postoperative 14th day all rats were sacrificed and intraabdominal adhesions were evaluated both macroscopically and microscopically, Macroscopically, postoperative adhesion formations in MB and CMS+SHA groups were significantly lower than that of control group (p<0,05X while there was no significant difference between MB and CMC+SHA groups. Microscopically giant cell reaction, fat necrosis, granulation tissue formation and fibrosis in MB group were significantly lower (p<0,05) than those of control group, while only granulation tissue formation and fibrosis in CMC+SHA group were significantly lower (p<0,05) than those of control group. it is concluded that both MB and CMC+SHA are effective in the prevention of postoperative peritoneal adhesions. However, MB may be a better choice because it is cheaper, easy to use, and it does not have any toxic or side effects.

RESULTS OF NECROSECTOMY IN PATIENTS WITH PANCREATIC NECROSIS

�MER �AKRAK, ABDULKAD�R BED�RL�, MUSTAFA KE�EL�, �ZHAN �NCE — 2000-06-01

The aim of this study is to review results of surgical treatment in patients with pancreatic necrosis. Despite recent advances in intensive care, imaging techniques and surgical strategies, the mortality rate of pancreatic necrosis is still high. In this report, the records of 18 patients (8 men, 10 women) who underwent surgical debridement for pancreatic necrosis at the Erciyes University Hospital from 1990to 1999 were reviewed retrospectively. Mean age was 52 (range 28 to 87), The etiology of acute pancreatitis was gallstones in eleven patients (61 %). According to findings of computerized tomography, the majority of patients were classified as grade D and grade E. Ten patients (56%) had infected necrosis, where as eight patients (44%) had sterile necrosis at the time of surgery. Patients were selected on the basis of an admission Acute Physiology and Chronic Health Evaluation (APACHE) II score, The mean APACHE II was found 17. Eleven patients required single debridements, whereas seven required 2 to 5 debridements. The average intensive care stay and the average lenght of hospital stay was 11 and 23 days respectively. The most frequent complication was pancreatic fistula (33%). Development of pancreatic pseudocyst occurred in 3 patients. Overall mortality was 44%. In conclusion, there are numerous surgical options for the management of pancreatic necrosis, Surgical debridement should be undertaken as quickly as possible in infected necrosis. However, making decision to surgery on patients with sterile necrosis is difficult, Most patients with sterile necrosis respond to intensive care unit treatment. Despite intensive care support if patients deteriorate and organ failure develops surgical intervention will be inevitable.

EFFECT OF EXTENSIVE LYMPH NODE DISSECTION ON THESURVIVAL OF PN0 AND PN1 GASTRIC CANCER

ERHAN RE�S, NUR� A KAMA, MUTLU DO�ANAY, MURAT KOLO�LU, MESUT ATLI, METE DOLAP�I — 2000-06-01

The therapeutic value of extended lymph node dissection (D2) for gastric cancer remains controversial. The purpose of this study was to determine whether extended lymph node (D2) dissections associated with a survival benefit for patients with histological pN0 and pN1 gastric cancer. Review of the prospective gastric cancer database at single institution of Ankara Numune Educational and Research Hospital from January 1992 to April 1999 were carried out. Totally 118 patients underwent potentially curative gastric resection, of these 91(77.1%) patients were identified to be histologically pN0 or pN1 according to hematoxylen-eosin staining. The ages of the patients ranged between 41 82(mean 61,8) years and 64(70.3%) patients were male. Mean follow-up period was 41 months for survived patients, 52 (57,1%) patients underwent limited lymph node(Dl) dissection and 39 (42,9%)patients underwent extended lymph node (D2) dissection. The morbidity was 27.5 percent and 9 (9.9%)patients died postoperatively, Five years survival was 33.3% for all patients, 22.5 % for who had D1 lymphadenectomy and 50.5%for who had D2 lymphadenectomy (p=0.0137)(compared by long-rank test), There was not any difference in postoperative morbidity (32.7% vs 20,5%) and mortality (10.3% vs9.6%) between two groups. Also there was not any difference between two groups according to chi-square test for prognostic factors.This study results show that extensive lymph node (D2) dissection improves the survival in pN0 and pN1 gastric cancer without increasing postoperative morbidity and mortality.

THE TREATMENT EFFICACY OF MEDICAL SPHINCTEROTOMY WITH GLYCEROL TRINITRATE ON ACUTE ANDCHRONIC ANAL FISSURES

AL� CO�KUN, AL� UZUNK�Y, � FARUK AKINCI — 2000-06-01

This study was planned to compare local application of nitric oxide donor ointment and anesthetic gel for the reduction of anal resting, squeeze pressures and also healing rates of acute and chronic anal fissures, Patients with anal fissures were divided into two (A and B) groups. There were 17 patients (acute10, chronic 7) in each groups. They were received respectively topical 2% nitric oxide donor ointment and 5% anesthetic lignocaine gel three timesa day during the four weeks period. Anal resting pressure, squeeze pressure and clinical examination were done a weekly intervals before and during the therapy periods. After one week treatment period, mean anal resting pressure was significantly reduced with topical nitric oxide donor ointment application in group A, but similar results were not observed in group B. Anal squeeze pressures were not significantly reduced by local applications in two groups. The healing rates were obtained 80 percent in acute (n=8)(p=0.001), 29 percent in chronic(n=2)(p=0.172)in group A and 60 percent in acute (n= 6) (p= 0.005), 0 percent in chronic (n= 0) in group B after four weeks therapy period. In this study, topical nitric oxide donor application causes to anal canal resting pressure reduction and improve vascular perfusion of anal fissure tissue. Patients were undergone operation for chronic anal fissure that resistant to medical management can be reduced with topical nitric oxide donor application.

REPAIR OF VENTRAL HERNIAS BY ANTERIOR FASCIA OF RECTUS

��KR� �ZER, �AK�R TEK�N, MUSTAFA �AH�N, MUSTAFA ATABEK — 2000-06-01

The aim of this study is to present a new technique called monolayer rectus fascial flap method whichis used for the repair of ventral hernias. Many different methods for the repair of ventral hernias, have been explained but they have had some disadvantages and surgeons are looking for new methods.We treated six cases with ventral hernia by this technique between April 1997-October 1998. In this method; anterior fascial layers of right and left rectus sheet are dissected by incising their lateral border.It was planned to cover the upper half of the defect with one side rectus muscle upper part fascial flap and lower half of the defect with other side rectus muscle lower part fascial flap. Free lateral lines of the flaps were sutured to the medial lines of the opposite rectus fascia and two flaps were suturedto each other in a transvers line at the middle plane. Mean follow up time was 12 (16-4) months. There was no recurrence and other complications during this period. We concluded that, this is a safe method for the repair of ventral hernias and can be used as an alternative method.