Turkish Journal of Surgery - 2007; 23(3)

Incidental carcinoma in patients operated for multinodular goiter

2007-09-01

Purpose: Our purpose is to detect the rate of incidental carcinoma in multinodulary goiter. However thyroid nodules' frequency is 4-7 % in normal population, malignant nodules are much rare. They represent only 0.2 % of deaths due to cancer. According to the investigations, malignant diseases of the thyroid gland is much more than detected values, but they are considered rare due to the slow and benign nature of the disease. �ncidental carcinoma frequency after evaluation of specimens of multinodular thyroid disease changes between 3- 16 % differentiating from population to population. Materials and Methods: In our study we evaluated 267 patients retrospectively and detected the incidental carcinoma ratio and evaluated treatment protocols. Result: In our patient group we found out that with considering the complication risks in benign diseases we prefered bilateral near total thyroidectomy or total thyroidectomy as the operative technique. Conclusion: Bilateral near total thyroidectomy or total thyroidectomy could be decided as the operative technique.

Role of granulocyte-macrophage colony stimulating factor on induced by ischemia-reperfusion liver regeneration in the experimental hepatic resection model

2007-09-01

Purpose: The aim of the study is to investigate the effects of Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) on ischemia-reperfusion induced apoptosis and hepatic regeneration in a partially hepatectomized rat model. Materials and Methods: Fifty rats were used and they were divided into five groups, each including ten rats. A juguler vein catheter placed to all except sham group and normal saline infusion was started 1 hour before operation. A midline laparotomy performed. Sham group rats were sacrified after portal dissection. Total ischemia performed to the other groups, after 70% hepatectomy the occlusion opened for reperfusion of the remnant liver. Before the operation (60 min.) 0.02 ml normal saline was given to control groups and 1 μg/kg GM-CSF was given to study groups subcutaneously administered. Blood samples were collected from v cava inferior for AST, ALT, LDH and sFas levels at the 2nd and 48th hours of reperfusion with performing relaparotomy. Remaining liver tissues were resected and weigthed. Relative liver mass, malondialdehyde (MDA), mitotic index and Fas immunohistochemical (IHC) staining evaluations from tissue samples were performed. Results: Mitotic index and relative liver weigths at GM-CSF group were significantly higher at 48th hour (p<0.05). AST,ALT ve LDH levels were increased at 2nd hour. However these levels were decreased in the study group at the 48th hour. Hepatic MDA level was high at 2nd but lower at 48th hour than other groups. sFas level and Fas IHC stainings were similar. But they were lower at 2nd and 48th hours in the GM-CSF group (p<0.05). Ischemia-reperfusion injury was high at 2nd hour and but there was no difference between saline and GM-CSF groups. However the injury decreased significantly at 48th hour, at the study group. Conclusions: GM-CSF, increases liver regeneration both morphologically and functionally after Pringle maneuver and partial hepatic resection. This application also decreases apoptosis and ischemia-reperfusion injury at the advanced stages of reperfusion.

The effects of synthetic patches used in laparoscopic ventral hernia repairs to intra-abdominal adhesions: Experimental study in rats

2007-09-01

Purpose: Today, synthetic patches are being used in open or laparoscopic ventral hernia repairs widely. We have aimed to examine adhesive potentials of various patches in rats treated with laparoscopic ventral hernia repairs. Material and Method: Rats were divided into six different groups with 8 subjects on each group: control (group 1), polypropylene (PP) (group 2), hyaloronic acid/carboxymethylcellulose coated polypropylene (PP+H/K) (group 3), expanded polytetraflouroethylene (ePTFE) (group 4), anti-adhesive collagen coated polyester (PO+AHK) (group 5) and polyester (PO) (group 6). Only laparoscopy was practiced on the rats in control group. PP, PP+H/K, ePTFE, PO+AHK and PO patches were placed on front abdominal walls of the rats by laparoscopy method. After two weeks, the rats were sacrificed. Frontal abdominal walls were opened with a wide (U) cut, adhesion force and adhesion area were evaluated. Photos of the adhesions as a result of patches were taken in all rats. Results: Intra-abdominal adhesion was not observed in the rats of control group. Adhesion was observed in all the rats with patches. But there were differences in terms of adhesion force and area. In the other patch groups other than polypropylene, the amount of adhesions was lower (p<0.05) than polypropylene group. The adhesion observed on polyester patch was equivalent to ePTFE and composite patches. In two composite patches coated with anti-adhesive material and ePTFE, similar adhesion was observed. In laparoscopic use of PP+H/K and PO+AHK composite patches, defects on anti-adhesive layer were observed as a result of tight rolling and intra-abdominal manipulations. Conclusion: Intra-abdominal adhesion was observed in all the patches. In laparoscopic use of composite patches, adhesions were higher probably as a result of defects in adhesive layers.

Perforated colorectal cancer: Postoperative short-term outcomes and factors influencing influencing the results

2007-09-01

Purpose: The aim of the current study was to evaluate various factors influencing the postoperative outcomes in patients with perforated colorectal cancer. Materials and Methods: Variables including age, sex, laboratory results, tumor localizations, site of perforation, presence of peritonitis, obstruction, metastasis or peritoneal seeding, stage of tumour, type of surgery, blood transfusions and Mannheim peritonitis index were analysed for their influence on the postoperative outcomes in 46 patients with perforated colorectal cancer, retrospectively. Results: Of the 46 patients 22 were female and 24 were male. The mean age of the patients was 57.4 years. Thirty-six patients had perforation at the tumour. The peritonitis was localised in 36 patients. Seventeen patients had primary resection and anastomosis, 27 patients had resection with colostomy/ileostomy. Two patients had no tumour resection. The postoperative morbidity and mortality rates were 32.6% (n=15) and 19.6% (n=9), respectively. In stepwise multivariate logistic regression analysis, Mannheim peritonitis index >29 (p=0.01) was the only significant predictor of morbidity and, Mannheim peritonitis index>29, ASA>II, presence of diffuse peritonitis and age>60 were significant predictors of postoperative mortality. Conclusion: Perforation of colorectal cancers is an abdominal emergency with high risk morbidity and mortality. Mannheim peritonitis index is closely related with morbidity. Additionaly, ASA score, advanced age and diffuse peritonitis are the factors that are significantly associated with mortality. Resection of the perforated bowel with tumour is mandatory and this may be followed by primary anastomoses in the case with localised peritonitis.

The effects of growth hormone on bacterial translocation and on the structural histopathologic changes of the liver and ileum in a rat model of obstructive jaundice

U�ur Do�an, Atila Korkmaz, Serpil Erci�, Handan Do�an — 2007-09-01

Purpose: The effects of growth hormone on bacterial translocation and on histopathologic changes both in the liver and small bowel together with the biochemical influences were aimed to investigate in a rat model of obstructive jaundice. Materials and Methods: Twenty-four Wistar albino male rats were used in the study. Animals were randomised and divided into four groups: Group IControl, Group II Sham, Group III Obstructive jaundiced animals and Group IV Treatment group(GH). GH, 250 microgram per kg per day, was administered subcutanously for 10 days. Blood samples were obtained for measurments of bilirubin, ALT, AST, ALP and GGT on the operation day through cardiac puncture. BT was evaluated taking specimens from mesenteric lymph node, liver, spleen and cecum via laparotomy under sterile conditions. Results: Statistically significant differerence was found between Treatment Group and other groups in terms of total and direct bilirubin levels(p<0.01). While ALT, AST and GGT levels in the Treatment Group were noted lower insignificantly comparing to those in the other groups, there was a significant difference between ALP levels of Treatment Group and others. Although structural disorders seen in the liver and small bowel manifested partial improvements in the Treatment Group, no statistically significant difference was found between the groups(p>0.05). While the BT rates were similar in Group III and Group IV, it was found decreased in the liver of the Treatment Group comparing to that of Jaundiced Group Conclusion: It has been concluded that GH provides partial improvements in biochemical parameters and BT rates in obstructive jaundice. Once the trophic and cytoprotective effects of GH on the liver and small bowel combined with its systemic influences are taken into account, GH administration may lead to decrease in morbidity and mortality due to obstructive jaundice.

Small bowel perforation after radiotherapy for cervical carcinoma

Burak Kavlako�lu, �brahim �st�n, Emine �nder, S�leyman Oral — 2007-09-01

Radiotherapy is one of the treatment modalities for carcinoma of the abdominopelvic organs. Radiation enteritis is a rare complication of abdominopelvic radiotherapy at the present time. Chronic radiation enteritis with complications, e.g. stricture, perforation and fistula formation, causes significant morbidity and mortality. We present a 32-year-old woman with cervical carcinoma, in whom small bowel (ileum) perforation developed 4 months after radiotherapy. Severe abdominal pain and signs of peritonitis were seen. Surgery was performed immediately. Two perforation sites were seen, ten centimetres and five centimetres of small bowel, including the perforation sites, were resected and anastomosed. No bowel adhesion was detected during the operation but bowel wall was very fragile. The postoperative course was uneventful, and the patient was discharged home 7 days after surgery. Histological examination confirmed post-irradiation injury. The complaints of patients with bowel perforation following radiotherapy varied, and signs of peritonitis may be lacking. Emergency Unit staff must be alert for small bowel perforations in patients who have been treated with radiotherapy.

Department of Surgery at Hacettepe University Faculty of Medicine

�skender Sayek, Kaya Yorganc� — 2007-09-01

The department of general surgery at Hacettepe was founded by Y�lmaz Sana� M.D. in 1963. So far, 152 general surgery trainees completed their residency program and continued their surgical and academic life in various parts of Turkey. Our department has followed Halstedian philosophy of surgical training from the very beginning and it was the first training program that applied 5 years of curriculum. In September 27, 2002, our department was accredited by European Board of Surgery.