Turkish Journal of Surgery - 2004; 20(3)

IMPACT OF TURKISH GENERAL SURGERY-RELATED ARTICLES PUBLISHED IN THE SCIENCE CITATION INDEX-EXPANDED TO THE INTERNATIONAL SCIENTIFIC COMMUNITY

Dr. iskender SAYEK, Dr. Kaya YORGANCI, Dr. B�lent TIRNAKSIZ — 2004-08-01

The number of scientific papers from Turkey that were published in the foreign scientific journals has dramatically increased in recent years. However it is not clear whether a similar trend has occurred in the citation rates of these papers. The aim of the present study was to evaluate the impact of Turkish general surgery-related articles published in the Science Citation Index-Expanded to the international scientific community. Articles published between 1954 an 2001 in 144 surgery journals included in the Science Citation Index-Expanded were evaluated using "Web of Science". General surgery-unrelated papers, editorials, letter to the editors, abstracts and expanded abstracts were excluded from the study. Number of papers published per year, citation rates, number of citation per article and rates of citations were studied. Out of total 522 articles, 262 were clinical and 167 were experimental original papers. There were 86 case reports, while only 4 review articles and 3 multicentric prospective studies were found. Before 1990, there were maximum 7 papers/year. After 1990, a significant increase in the annual number of articles was observed and more than 50 papers/year were published after 1998. There were totally 1484 citations. Mean and median number of citations per paper was 2.84 and 1, respectively. Forty-three percent of the articles received no citation and 148 papers received only one or two citations. Seventy-seven percent of total citations were from foreign scientific community. From national citations, 34.4% were self-citations. We conclude that although there was a significant increase in the number of articles published in the surgery journals included in the Science Citation Index - Expanded, there was no concomitant increase in the citation rates.

VIRAL TRANSMISSION DURING SURGERY: WHAT DO WE KNOW?

2004-08-01

Surgeons are frequently exposed to blood and body fluids that have the potential to transmit disease. During surgery, intact gloves act as a protective barrier against bloodborne pathogens. In this study, we investigated the knowledge of the surgeons and residents at our hospital about the transmission risk of the three bloodbome viruses most commonly involved in the health care setting: human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). We also investigated their immunization against the HBV, gloving attidues and puncture rates during surgery. A survey form was filled reciprocally with physicians who accepted to answer. From surgical specialties, a number of 127 physicians consisting of 78 resident (%61) and 49 staff surgeon (%39) participated to our questionnaire. The rate of immunized, naturally immunized and those who were checked their an-ti-HbS titration at least once among the respondents were %79, %1 2 and %52 respectively. While the estimation ratio of the transmisson risk for HBV and HCV was both %25, only %10 of the respondents estimated the transmission risk for HIV correctly. The needle puncture rates in major risk vs minor risk specialties (p=0.002) and in residents vs staff surgeons (p=0.0001) were significantly higher. However, the rate of double gloving was only %4.7 in all series. The proportion of double glovers were significantly higher among staff surgeons (p=0.004).

THE RESULTS OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE BILIARY PANCREATITIS FOLLOWING SIGNS OF CLINICAL IMPROVEMENT DURING INITIAL ADMISSION

2004-08-01

The aim of this study was to evaluate the results of delayed (following signs of clinical improvement during initial admission) laparoscopic cholecystectomy (LC) in acute biliary pancreatitis (ABP). Although cholecystectomy is recommended for prevention of further attacks of ABP, LC in the treatment of ABP is contraversial due to technical difficulty. The data of this retrospective study is obtained from the medical records of patients who admitted to our surgical department from January 1997 to December 2003. Diagnostic criteria were specified according to the the history, clinical examination, biochemical and radiological findings. Following selective ERC, patients underwent LC after clinical and biochemical resolution of attack. Age, gender, biochemical, ERC and radiological findings, conversion rate to laparotomy, operating time, intraoperative and postoperative morbidity and mortality rates, and time of hospital stay were evaluated. There were 55 patients (45 females, 10 males) with a median age of 54 (1 7-76) years. The procedure was converted to open surgery in 7 (13%) patients. Median operating time was 60 (20-140) min.The overall morbidity rate was (11%) 6 patients. Median preoperative hospital stay time was 14 (5-17) days and postoperative stay time was 1 (1-4) days. There was no mortality. Although conversion rate to open surgery is high, delayed laparoscopic cholecystectomy can be performed safely in patients with acute biliary pancreatitis following signs of clinical improvement during initial admission.

FACTORS THAT PREDICT MORBIDITY AND MORTALITY IN PATIENTS WITH PERFORATED PEPTIC ULCERS

2004-08-01

In this study it is aimed to describe the risk factors predictive of mortality and morbidity in patients that underwent emergency surgery for peptic ulcer perforation. Patients operated on for peptic ulcer perforation in 3. General Surgery Department of �i�li Etfal Training and Research Hospital between March 2001-June 2003 were analyzed prospectively. Using APACHE II scoring system, patients were divided into two groups. Patients with a score greater than five has been described as high-risk group. Also patients with comorbid conditions, delay to surgery (>24 hours) and ulcer perforation size (>1 cm) had been identified as other parameters. There were 60 males (84.5%) and 11 females (15.5%) with a mean age 39.13 years (range 17-82). Nine patients had postoperative complications, including pneumonia (2 patients), evisceration (2 patients), intraabdominal abscess (2 patients), gastric leakage (2 patients) and cardiopulmonary failure (1 patient). According to APACHE II scoring system there were 11 patients in the high-risk group and 6 patients in this group had postoperative morbidity (p=0.000), 1 patient had mortality. Eleven patients had comormid conditions, 4 patients with comorbid conditions had postoperative morbidity (p=0.027). There were 13 patients with a delay of surgery 24 hours after onset of symptoms, and 4 patients in this group had morbidity (p=0.350). Ulcer size was greater than 1 cm in 7 patients and 5 of these had postoperative complications (p=0.000). 34 (47.8%) patients were over 40 years of age and 8 (23.5) of these patients had postoperative complications (p=0.011). Evaluating patients who underwent emergency surgery for peptic ulcer perforation using by APACHE II scoring system additionally describing other risk factors (comorbid conditions, ulcer size, delay of surgery, age) gives a detailed documentation about morbidity rate and helps selecting the modality of surgical treatment.

COMPARISON OF PRIMARY CLOSURE AND RHOMBO�D FLAP TRANSPOSITION TECHNIQUES IN THE TREATMENT OF PILONIDAL SINUS DISEASE

2004-08-01

In the surgical treatment of chronic pilonidal sinus disease, primary closure and rhomboid flap transposition techniques were compared according to the early complications and recurrence rates. There are various operative techniques in the management of pilonidal sinus disease. Recurrence rates are high regardless from the operative technique. Flap transposition techniques have not proven to be superior to the primary closure. Sixty-nine patients were evaluated prospectively. All patients were primary cases and were divided into two groups in a randomized manner. In group A primary closure and in group B rhomboid flap transposition techniques were used. Student's t test (for the hospital stay and drainage time) and chi-squared test (for early complications and recurrence rates) were used to determine the statistical difference. There were no statistically significant difference between the groups according to duration of the hospitalization period, duration of the wound healing, and average follow up period (p>0,05). Postoperative early complication rate was significantly higher in group A (p<0,05) and recurrence rate was significantly higher in group B (p<0,05). Usage of drain, mean drainage period and the need for general anesthesia were significantly higher in group B (p<0,05). The choice of treatment in the surgical management of pilonidal sinus should be simple, comfortable for the patient and have a low recurrence rate. There was less need of drain usage and general anesthesia in the patients underwent excision with primary closure without recurrence in the follow up period. In addition to the advantages mentioned above, primary closure is a simple technique. As a conclusion we suggest the primary closure technique as a choice of procedure in the management of pilonidal sinus disease.