[Show abstract][Hide abstract] ABSTRACT: Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease; however, adverse hemodynamic changes induced by increased intraabdominal pressure due to pneumoperitoneum are known to occur. Herein, we investigated the effects of pneumoperitoneum on oxidative stress markers, including paraoxonase, arylesterase, total oxidant status, and total antioxidant status, during laparoscopic cholecystectomy.
Patients that underwent a laparoscopic cholecystectomy were classified as Group I, whereas patients that underwent surgical procedures for an abdominal wall hernia under general anesthesia were classified as Group II. Blood samples were obtained during the preoperative period, the perioperative period, and 24 hours after surgery (postoperative day 1). Leukocyte counts, neutrophil rates, paraoxonase activities, arylesterase activities, and total oxidant and antioxidant status levels were measured.
The differences in leukocyte counts and neutrophil rates were not significant between the two groups. In Group I, no significant differences in the total oxidant and antioxidant status levels were identified; however, paraoxonase and arylesterase levels were lower on postoperative day 1. No significant changes were observed in the total oxidant status, total antioxidant status, and paraoxonase or arylesterase activities in Group II. The perioperative total antioxidant status and arylesterase level were higher in Group I in comparison to Group II.
Paraoxonase and arylesterase levels are useful markers in the evaluation of oxidative stress caused by intraabdominal pressure due to pneumoperitoneum.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Elevation of intraabdominal pressure by means of gas insufflation produces hemodynamic disturbances in the peritoneal viscera, leading to splanchnic ischemia. Recently, ischemia modified albumin (IMA) has been used to investigate conditions such as myocardial and skeletal muscle ischemia. The purpose of this clinical investigation is to determine the role of IMA in the evaluation of alterations in blood flow of the splanchnic area and abdominal viscera during laparoscopic cholecystectomy. Patients and Methods: Twenty two patients (F/M: 21/1) undergoing laparoscopic cholecystectomy (Group I) and 10 patients (F/M: 7/3) undergoing various surgical procedures under general an- estheasia (Group II) were studied. No patient had any cardiovascular disease. Blood samples for IMA were collected at preoperative and intraoperative periods. A rapid, colorimetric assay was used to measure serum IMA levels. Results: In Group I, the preoperative and intraoperative IMA levels were 0.59±0.16 absorbance units (ABSU) and 0.74±0.17 ABSU, respectively. The intraoperative IMA levels were higher than the preoperative levels (p=0.025). In Group II, the preoperative and intraoperative IMA levels were 0.43±0.12 ABSU and 0.52±0.15 ABSU, respectively. The difference was not statistically significant (p=0.22). The intraoperative IMA levels in Group I were higher than Group II (p=0.003).Conclusion: IMA, a new sensitive marker for ischemia, can be helpful for determining alterations in blood flow of the splanchnic area and abdominal viscera during laparoscopic cholecystectomy. cholecystectomy, splanchnic area.
Turkish Journal of Surgery 01/2010; 26(2). DOI:10.5097/1300-0705.UCD.449-10.0
[Show abstract][Hide abstract] ABSTRACT: Phyllodes tumor (PT) is a rare neoplasm comprising less than 1% of all breast tumors. Its clinical spectrum ranges from a benign and locally recurrent form of behavior to malignant and metastatic forms. The aim of the study was to evaluate the clinical characteristics, treatment regimens, survival and late complications in patients with PT.
We retrospectively reviewed the medical records of 10 women who were treated for PT in our center between 1998 and 2002. All cases were histologically examined by an experienced breast pathologist, and tumors were classified as benign, borderline malignant or malignant according to standard histological criteria.
The median age at diagnosis was 45.5 years (range: 21-69 years). Seven (70%) of 10 tumors were benign and 3 (30%) were malignant. The median tumor size was 29 mm (range: 12-80 mm). The least safe margin was 1 cm. Three of 10 patients had malignant PT and underwent simple mastectomy. Local recurrence was determined in no patients. Only one patient had lung metastasis. Median follow-up period was 62 months (range, 12-96 months). The patient with lung metastasis was treated with doxorubicine but died one year after the operation.
PT is a rare neoplasm of the breast. It resembles fibroadenoma. Local excision with appropriate surgical margins seems adequate in all patients (Tab. 1, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.
Bratislavske lekarske listy 01/2010; 111(5):271-4. · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The appropriate choice of surgical treatment of hepatic hydatidosis depends on the communication between the cyst and the bile ducts. The forms of cavity management and biliary drainage procedures proposed for the case of cysts with bile duct communication vary greatly while the ideal operation is still controversial. Herein, we report partial cystectomy plus cystojejunostomy (with stapler) in a case with hepatic hydatid disease (Fig. 2, Ref. 7).
Bratislavske lekarske listy 01/2010; 111(6):349-50. · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neurofibromatosis (NF) type 1, also known as von Recklinghausen's disease, is an autosomal-dominant inherited disorder. Some tumors may develop in these patients, including optic pathway gliomas, astrocytomas, brainstem gliomas, chronic myeloid leukemia, and rhabdomyosarcoma. Patients with neurofibromatosis type 1 show also an increased risk of endocrine tumors, especially pheochromocytomas, whereas thyroid carcinoma is very rare. It is also rare for a neurofibroma to arise in the tissue neighboring the thyroid gland, and mimicking a nonfunctional thyroid nodule. This report presents a case of a neurofibroma adherent to the thyroid gland with thyroid papillary carcinoma in a 26-year-old woman with NF type 1.
Surgery Today 10/2009; 39(10):884-7. DOI:10.1007/s00595-008-3946-9 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intestinal anastomotic healing is a complex procedure in which several mediators and cytokines play roles. Calcitonin gene-related peptide is an important neuropeptide in inflammation. In this study we aimed to investigate the effect of calcitonin gene-related peptide on healing of intestinal anastomosis in rats with obstructive jaundice.
Obstructive jaundice was induced in rats by the ligation and division of the common bile duct. Four days after the operation, intestinal anastomosis was performed, and either calcitonin gene-related peptide or 0.9% NaCl was administered intraperitoneally to these jaundiced rats and controls. The concentrations of serum tumor necrosis factor-alpha (TNF-alpha) and triglyceride levels of all rats were measured, and healing of the anastomosis was evaluated by measuring the bursting pressure and hydroxyproline content on the 7th postoperative day.
Calcitonin gene-related peptide was found to have positive effects on healing of the anastomosis by inhibiting the effects of TNF-alpha and increasing the bursting pressure and hydroxyproline content of the anastomosis.
Calcitonin gene-related peptide increases anastomotic wound healing in experimental anastomosis in the presence of obstructive jaundice in rats.
Journal of Hepato-Biliary-Pancreatic Surgery 05/2009; 16(4):546-51. DOI:10.1007/s00534-009-0098-2 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to compare the dual phase MIBI scinitgraphy with MIBI and Tc-99m pertechnetate (MIBI + Tc-99m) study in defining the parathyroid adenomas, and to evaluate the effect of histologic and biochemical characteristics on the imaging of parathyroid adenomas with Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy.
Thirty-six patients with parathyroid adenomas were studied prospectively. All patients were evaluated with both MIBI and (MIBI + Tc-99m) study. MIBI uptake of adenomas correlated with oxyphill, chief cell and tumour weight of the surgically excised glands. MIBI uptake was also compared with serum calcium (Ca), phosphorus (P) and intact parathormone (iPTH) levels.
A total of 38 parathyroid adenomas were surgically excised from 36 patients. MIBI + Tc-99m identified 35 of the parathyroid lesions (92%). Whereas, MIBI study detected 30 of the 38 parathyroid adenomas (79% sensitivity) (p=0.0001). There were no false positives. Adenoma weight showed significiant correlation with MIBI uptake (p=0.001). Oxyphyill cell content also showed high correlation with MIBI uptake. Delayed images showed better correlation than the early views (Early MIBI p=0.033; Delayed MIBI; p=0.001).
MIBI + Tc-99m pertechnetate interpretation is more sensitive than only dual MIBI imaging for the detection of parathyroid adenoma. Oxyphill cell content and weight of the lesions proved to be important determinants of 99mTc-MIBI accumulation in parathyroid adenoma. We found no significant correlation between MIBI accumulation, Ca, P and iPTH serum levels (Tab. 2, Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.
Bratislavske lekarske listy 02/2009; 110(3):166-9. · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of infliximab on adhesion formation and it's associated morbidity and complications.
This study was performed in the Faculty of Medicine, Gazi University, Turkey between July 2005 and October 2005. Thirty-five rats were randomly divided into 4 groups. Laparotomy was performed in the Sham group (n=5), whereas cecal abrasion was carried out in all other groups. After cecal abrasion 0.9% sodium chloride was administered in the saline group (n=10), infliximab was administered to the study group (n=10) and nothing was administered to the last group (n=10). Adhesion formation was evaluated with macroscopic and microscopic adhesion scoring systems. Peritoneal fluid samples and mesenteric lymph node biopsies were taken to rule out bacterial peritonitis. Blood and peritoneal irrigation fluid samples were taken to measure the Tumor necrosis factor-alpha (TNF-alpha) levels.
Macroscopic adhesion scores showed fewer adhesions in the infliximab group. The infliximab group had significantly fewer adhesions than the abrasion control and saline groups. According to the histological findings, there were no statistically significant differences between the groups.
Early blocking of the activity of TNF-alpha after cecal abrasion resulted in lower rates of adhesion formation, macroscopically. The TNF-alpha, a proinflammatory cytokine appears to be an important mediator for postoperative adhesion formation.
Saudi medical journal 01/2008; 28(12):1830-5. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia.
Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded
No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001).
Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.
The West Indian medical journal 12/2007; 56(6):530-3. · 0.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cowden syndrome is a multisystemic cancer predisposition disorder, in which the mucocutaneous lesions are the most constant features. We present a case of Cowden syndrome in a teenage boy with hyperkeratotic papules of the facial skin, especially on the eyelids, with episcleritis, proptosis, and papillomatous lesions on the tip of the tongue and lip mucosa. In addition, two nodules in the thyroid gland were detected. On laboratory examination, the carcinoembryonic antigen (CEA) was 34 ng/mL (normal limits: 0-3 ng/mL). Total thyroidectomy was performed. Histopathologic examination of the specimen revealed thyroid medullary carcinoma. After operation, levels of CEA decreased to normal limits.
The Laryngoscope 08/2007; 117(7):1180-2. DOI:10.1097/MLG.0b013e318058a0b7 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical characteristics and outcome of patients with parathyroid adenoma.
We diagnosed and operated 54 patients with primary hyperparathyroidism in the Faculty of Medicine, Gazi University, Turkey from January 2000 to December 2004. In this study, 52 (96.2%) of these patients who had parathyroid adenoma were retrospectively evaluated.
There were 46 female, and 6 male patients with a median age of 54.5 years (range, 18-87 years) at diagnosis. Preoperative mean serum level of calcium was 11.09 +/- 0.9 mg/dL, while phosphorus was 2.3 +/- 0.5 mg/mL, and parathyroid hormone (PTH) was 338.99 +/- 416.43 pg/ml. Ultrasound imaging revealed parathyroid adenoma in 38 of the 52 patients (73%), while 27% of the patients were normal. In 29 (69%) of the 42 patients who had sestamibi scanning, results revealed parathyroid adenoma and in the others (31%), sestamibi scanning was normal. On the postoperative period, the mean serum calcium level was 9.2+/- 0.74 mg/dL (p=0.0001 compared to preoperative level), phosphorus was 2.7 +/- 0.39 mg/mL (p=0.07 compared to preoperative level), and PTH level was 41.01 +/- 43.03 pg/ml (p=0.0001 compared to preoperative level). All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period.
Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and PTH levels are the most useful parameters for diagnosis. Preoperative screening methods and operative findings are not always correlated so the patients with high serum calcium and PTH should be planned for surgery, independent of radiological results. All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period.
Saudi medical journal 08/2006; 27(7):1034-7. · 0.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We discuss the operative challenges posed by the advanced laparoscopic approach for a patient with situs inversus totalis. The patient was a morbidly obese woman with multiple co-morbidities related to her weight. The modifications in the surgical technique include the insertion of trocars according to the mirror image anatomy of the intra-abdominal organs under laparoscopic visualization. We suggest preoperative abdominal ultrasound in order to diagnose both gallbladder stones and also the reverse location of intra-abdominal organs that is rarely seen. A laparoscopic gastric banding, not a contradiction for situs inversus totalis, was performed successfully.
Obesity Surgery 11/2005; 15(9):1344-6. DOI:10.1381/096089205774512591 · 3.75 Impact Factor