[Show abstract][Hide abstract] ABSTRACT: Purpose: Alteration in oxygen saturation is a side effect of
the dye used in sentinel lymph node biopsy. The object of
this study was to determine the possible effects of methylene
blue on the oxygen saturation in patients undergoing sentinel
lymph node biopsy. Methods: The complete peroperative
records of 148 patients who underwent sentinel lymph node
biopsy with intraparenchymal injection of methylene blue
were reviewed. The data reviewed included the preinjection
pulse oximeter saturation readings and the postinjection
values until the readings returned to the preoperative levels
in the postanesthesia care unit. Results: The pulse oximetry
values were recorded preoperatively, after intubation and, at
15, 30, 45, and 60 minutes of the operation. The results
showed that methylene blue did not cause any significant
changes in oxygen saturation levels. Conclusion: We sug-
gest that methylene blue might be preferable for the patients
with concomitant disease, and for whom close monitoring
of their oxygen saturation is required.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Familial Mediterranean fever (FMF) is an autosomal-recessive disease characterized by recurrent attacks of fever with serositis. Differential diagnosis of a FMF abdominal attack with acute abdomen is difficult. Acute appendicitis is the most common cause of acute abdominal pain that requires surgical treatment. The aim of this study was to investigate frequency of FMF in patients with negative appendectomy.
We assessed 278 patients (female/male 127/151) who were operated with preoperative diagnosis of acute appendicitis. In 250 of the patients, definitive diagnosis of acute appendicitis was established by histo-pathological examination. Patients with negative appendectomy were assessed for FMF by rheumatologist.
Negative appendectomy was detected in 28 patients (M/F 5/23, mean age 25.3 ± 8.4 years). Negative appendectomy ratio was 10.1 %. Among 28 patients two had FMF (7.7 %).
FMF were established in 7.7 % of patients with negative appendectomy. Our study suggests patients having negative appendectomy should be evaluated for FMF. Further large sample studies are needed to define the real prevalence of FMF among negative appendectomy patients.
Modern Rheumatology 06/2012; 23(2). DOI:10.1007/s10165-012-0688-8 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
Alteration in oxygen saturation is a side effect of the dye used in sentinel lymph node biopsy. The object of this study was to determine the possible effects of methylene blue on the oxygen saturation in patients undergoing sentinel lymph node biopsy.
The complete peroperative records of 148 patients who underwent sentinel lymph node biopsy with intraparenchymal injection of methylene blue were reviewed. The data reviewed included the preinjection pulse oximeter saturation readings and the postinjection values until the readings returned to the preoperative levels in the postanesthesia care unit.
The pulse oximetry values were recorded preoperatively, after intubation and, at 15, 30, 45, and 60 minutes of the operation. The results showed that methylene blue did not cause any significant changes in oxygen saturation levels.
We suggest that methylene blue might be preferable for the patients with concomitant disease, and for whom close monitoring of their oxygen saturation is required.
Journal of Breast Cancer 03/2009; 12(1). DOI:10.4048/jbc.2009.12.1.32 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Leiomyomas are mostly of benign character and are rarely seen in the gastrointestinal (GI) system. They represent one subgroup of a group of tumors known as gastrointestinal stromal tumors (GIST). Although rarely seen, they are symptomatic tumors, and they comprise 20-30 percent of all benign GI tumors. Diagnosis is difficult because of their rarity and the absence of specific symptoms. This is a case report of intestinal leiomyoma in a patient who was suffering with GI obstruction for more than 5 months. The tumor was discovered only after the appearance of intestinal obstruction. The patient underwent laparotomy for ileus of unknown etiology. Leiomyoma was diagnosed by pathologic analysis.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 01/2007; 73(8):1079-81. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal bleeding is a life-threatening manifestation of intestinal tuberculosis that is generally attributed to oozing of blood from the mucosal ulcers. We report a case of intestinal tuberculosis presenting with massive upper gastrointestinal bleeding from jejunal artery pseudoaneurysm diagnosed with angiography and successfully embolizated by histoacril (glue).
Journal of Emergency Medicine 12/2006; 31(4):391-4. DOI:10.1016/j.jemermed.2006.07.017 · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the case of a 30-year-old woman with a benign epidermoid splenic cyst and a high CA 19-9 serum level (268 U/mL). The patient underwent resection of the cyst and splenectomy. After removal of the cyst, the serum CA 19-9 level decreased to a normal level within 6 weeks. True non-parasitic splenic cysts are rare. Approximately 30 cases of benign true splenic cysts with a high CA 19-9 serum level have been published.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 11/2006; 73(6):871-3. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal manifestations of both Behçet's disease and intestinal tuberculosis include the signs and symptoms of abdominal pain, weight loss, fever, vomiting, diarrhea and palpable mass in the right lower quadrant. We report the case of a male patient with Behçet's disease who had multiple ileal perforations due to miliary tuberculosis. It was suspected that the perforations were due to intestinal manifestation of Behçet's disease, but the final pathology report and chest X-ray one week after surgery demonstrated the presence of miliary tuberculosis. To our knowledge, this is the first reported case of Behçet's disease with intestinal perforation due to miliary tuberculosis.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 10/2006; 73(5):825-7. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: True nonparasitic splenic cysts are rare. Reports of approximately 30 cases of benign true splenic cysts producing elevated CA 19-9 serum levels have been published. The traditional treatment of splenic epidermoid cysts is splenectomy. However, with all the advances in laparoscopic surgery, conservative laparoscopic approaches are accepted as the most preferred techniques for this benign disease. Laparoscopic cystectomy with its minimal invasiveness and low morbidity is the ideal technique for properly selected patients. So far, only one case report of laparoscopic cystectomy for splenic epidermoid cyst with elevated CA 19-9 levels has been published. This is the second known report of this procedure being performed to remove a splenic epidermoid cyst in a patient with elevated CA 19-9 levels.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 04/2006; 10(4):507-10. · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spontaneous cholecystocutaneous fistula is a rare complication of chronic calculous cholecystitis. This complication, a result of the natural history of gallbladder stones, was formerly common. Today it is rare, because of early diagnosis and treatment of biliary tract diseases. We report a case of spontaneous cholecystocutaneous fistula in a 70-year-old female patient who presented with an abscess formation in the right upper quadrant. After the incision of this infective focus, many gallstones were picked up. One-stage open cholecystectomy and excision of the fistula tract were carried out after control of the abdominal wall infection.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 12/2005; 72(6):402-4. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of a premenopausal woman with severe constipation causing intermittent obstruction. Colonoscopy revealed a tight rectal stricture; however, mucosal biopsies were normal. Exploratory surgery revealed an intense fibrotic reaction involving the rectum and uterus, necessitating a simultaneous low anterior resection and hysterectomy. Pathology established a diagnosis of endometriosis. Preoperative diagnosis of rectal endometriosis can be difficult to establish. Endometrial deposits do not invade the mucosa; therefore, colonoscopy with biopsies are frequently non-diagnostic. Surgery may be the only definitive way to obtain a certain diagnosis. In cases involving rectal strictures of unknown etiology in premenopausal women, rectal endometriosis must be included in the differential diagnosis.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 12/2005; 72(6):405-8. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to assess the effecacy of clip application in the surgical repair of iatrogenic colonic perforations.
Twenty adult male Wistar-Albino rats were divided into two equal groups of ten. In both of the groups an iatrogenic perforation was made in the anti-mesenteric border of the left colon. The defect was closed with interrupted 6/0 polypropylene sutures in group 1 and extraluminal application of vascular clips (VCS--vascular clip system) in group 2. All animals were killed on postoperative Day 4. Wound healing was evaluated with both in situ bursting pressure and hydroxyproline levels.
There was no statistically significant difference between the two groups in respect of bursting pressure levels (p = 0.063) whereas hydroxyproline levels were higher in group 2 (p = 0.0021).
Surgical repair of iatrogenic colonic perforations by extraluminal clips gives comparable results according to wound healing parameters. This approach may be a rational alternative to suture or endoscopic repair methods.
[Show abstract][Hide abstract] ABSTRACT: Although there are many reports describing spontaneous rupture of either the spleen or the liver, the simultaneous rupture of both organs is a rare event, especially during anticoagulant therapy. We report a case of spontaneous rupture of the spleen and liver in a patient on warfarin therapy for deep venous thrombosis.
Surgery Today 02/2005; 35(3):252-5. DOI:10.1007/s00595-004-2898-y · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recombinant human growth hormone and nandrolone phenylpropionate are two different anabolic agents. This study was designed to investigate the effects of these anabolic agents on the healing of ischemic colon anastomosis in rats.
Seventy adult male Wistar rats were divided into five groups (n = 14). Group I was the sham laparotomy group. In the other groups, surgical procedures consisting of transsection and anastomosis were made at a distance 3 cm from the peritoneal reflection. Group II was the nonischemic control group. Ischemic colon model was produced in the remaining groups. Group III was the untreated control group. Groups IV and V received recombinant human growth hormone and nandrolone phenylpropionate, respectively. Bursting pressure and hydroxyproline levels were measured on the third and seventh postoperative days to evaluate anastomotic healing.
Recombinant human growth hormone increased both collagen deposition and bursting pressure significantly at postoperative Days 3 and 7 compared with the sham and untreated control groups (P < 0.005). When compared with the untreated control, nandrolone phenylpropionate significantly increased collagen deposition at postoperative Days 3 and 7 (P < 0.005) and bursting pressure only at postoperative Day 3 (P < 0.005).
Recombinant human growth hormone has more favorable therapeutic effects on the healing of ischemic colonic anastomoses than nandrolone phenylpropionate. Recombinant human growth hormone also improves healing of nonischemic colonic anastomosis.
Diseases of the Colon & Rectum 01/2004; 46(12):1690-7. DOI:10.1097/01.DCR.0000098912.12000.D6 · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors introduce a new instrument functioning as both perforator and aspirator in the laparoscopic management of hepatic hydatid cysts. Between January 1998 and January 2002, 11 laparoscopic cystotomy + partial cystectomy + drainage procedures were performed for eight consecutive patients. Eight of the cysts were located in the right lobe, and the remaining three in the left. The average diameter (+/-SD) of the cysts was 9.6 +/- 3.66 cm, and the mean age of the patients was 31.3 +/- 7.24 years. The diagnosis was confirmed by ultrasonography and/or computerized tomography. The procedure was performed with the help of three ports. The "perfore-aspirator" instrument (Bahadir Tibbi Aletler A. S., Samsun, Turkey) was introduced through the 10-mm trocar at the subcostal area, and the cystotomy procedure was done with success. Then, a partial cystectomy procedure was performed with the use of a grasper and scissors attached to an electrocautery device. The average hospitalization period was 5 +/- 1.69 days. No major morbidity or mortality was seen. All patients were treated with albendazole preoperatively and postoperatively.
[Show abstract][Hide abstract] ABSTRACT: Incisional hernia is a frequent complication of abdominal surgery developing in 11-20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group ( P<0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair.
[Show abstract][Hide abstract] ABSTRACT: A hydatid cyst is still a serious health problem in endemic areas. Invasion of the spleen is rare in hydatid disease. In the medical literature, reports about isolated splenic hydatidoses are quite rare. Also there is not a consensus about the way of treatment.
Between 1978 and 2000, in our clinic approximately 900 patients were operated on for an abdominal hydatidosis; 850 of these patients were treated for a hepatic hydatidosis and 14 patients for an isolated splenic hydatidosis. Six (42.8%) of the latter patients were male and 8 (57.1%) were female. The mean age of the patients was 47.14 +/- 4.9 (range 17-72) years. Ten patients (71.4%) presented with a painful mass in the left upper quadrant of the abdomen, and the other 4 patients (28.5%) were asymptomatic and were diagnosed incidentally.
All of the patients underwent elective splenectomy. There was no mortality, but complications occurred in 4 (28.5%) patients. The period of hospitalization ranged from 7 to 17 days with a mean of 9.8 days. 1 patient died from an acute myocardial infarction during the 2nd postoperative year, and 1 patient died as a consequence of a traffic accident during the 5th postoperative year. Nine patients, after follow-up periods of between 2 and 14 years, are living free from disease. No recurrence occurred in any of them. In the remaining 3 patients, long-term follow-up could not be maintained.
A hydatid cyst must be included in the differential diagnosis of cystic lesions of the spleen. A splenic hydatid cyst should be treated surgically due to the high risk of a rupture, and the ideal procedure in adulthood is standard splenectomy.
Digestive Surgery 02/2003; 20(1):38-41. DOI:10.1159/000068864 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 1% of breast cancers occur in men. The etiology is obscure. An elevated BMI has been postulated to be a cause.
All male breast cancer patients operated from January 1990 to May 2001 were retrospectively reviewed. Relation between BMI and male breast cancer was examined.
43 males underwent breast surgery for breast cancer during this period. 3 patients were excluded from the study because of other risk factors for breast cancer. The average BMI of 40 patients was 26.54 kg/m2, which is mildly above the level for normal weight.
Excessive adipose tissue may increase risk of male breast cancer.
Obesity Surgery 01/2003; 12(6):869-70. DOI:10.1381/096089202320995727 · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of pneumoperitoneum on the peritoneal defense mechanism induced by streptozocin infusion during laparoscopic surgery in diabetic rats and to show the importance of regulation of diabetes for peritoneal defense mechanisms. One hundred twenty-six Sprague-Dawley male rats were allocated into six groups each consisting of 21 rats: group 1, nondiabetic sham laparotomy (control); group 2, nondiabetic pneumoperitoneum (control); group 3, uncontrolled diabetes plus sham laparotomy; group 4, controlled diabetes plus sham laparotomy; group 5, uncontrolled diabetes plus pneumoperitoneum; and group 6, controlled diabetes plus pneumoperitoneum. Diabetes was constituted by intraperitoneal infusion of one dose of 60 mg/kg streptozotocin, and diabetes was regulated (in groups 4 and 6) by subcutaneous injection of 10 IU/kg insulin in the morning and evening after the blood glucose measurements since the fourth day. Peritoneal fluid samples were taken at the zero, second, and sixth hours after sham laparotomy for groups 1, 3, and 4 and after pneumoperitoneum for groups 2, 5, and 6 on the seventh day. Total peritoneal cell count, antibacterial activity of the peritoneal fluid, and types of phagocytic cells in the peritoneal fluid were assessed. Peritoneal cell count was found to be lower in uncontrolled diabetes due to high blood glucose levels (>200 mg/dL), which led to slow migration of phagocytic cells into the peritoneum. Pneumoperitoneum had augmented the effect on phagocytic cell migration to the peritoneum compared with the sham laparotomy in controlled diabetic rats. Uncontrolled and controlled diabetes have adverse effects on peritoneal defense mechanism killing functions by interfering with the antimicrobial activity of peritoneal fluid.