[Show abstract][Hide abstract] ABSTRACT: Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.
Full-text · Article · Feb 2015 · The American surgeon
[Show abstract][Hide abstract] ABSTRACT: Preoperative staging of rectal cancer plays an important role in planning therapy. In order to choose the treatment, regional invasion and possible metastasis of the tumor should be investigated in patients with rectal cancer clinically and histologically. As a result of this evaluation, the surgical strategy will be determined, and also a need of neoadjuvant therapy can appear. In our study, 32 patients with rectal cancer were examined. All of the patients underwent ERUS examination and were staged according to ultrasonographic TN classification. Patients were separated according to their rectal localization (inferior, middle, superior) and stage. The specimens obtained during the operations were examined and staged histopathologically. Preoperative staging with ERUS, was compared with postoperative histopathologic staging. The accuracy rates of ERUS were 71,9 percent in staging depth of rectal wall invasion, and 68,8 percent in staging lymph node metastasis. As a conclusion, because ERUS is safer, easy to perform and does not need any preoperative procedure, is determined as an appropriate method for preoperative staging of rectal cancer.
No preview · Article · Jan 2014 · Gulhane Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Objectives: The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fissures using the endoanal ultrasonography.Background: Lateral internal sphincterotomy is an effective method in treatment of chronic anal fissures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the efficiency of the treatment. Methods: Totally, 40 patients with unhealed anal fissures after the lateral internal sphincterotomy were enrolled consecutively. The fissures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography. Results: There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superficial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be sufficient, a localized abscess formation of less than 1 cm was detected at the anal crypts level. Conclusion: The use of endoanal ultrasonography in patients with unhealed or recurrent anal fissure is a beneficial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31). Keywords: anal fissure, lateral internal sphincterotomy, unhealing, endoanal ultrasonography.
No preview · Article · Jan 2013 · Bratislavske lekarske listy
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the expressions of oncoproteins and to correlate the results with clinicopathologic parameters in papillary thyroid carcinoma (PTC). Papillary thyroid cancer (PTC) is the most common form and accounts for about 80% of all thyroid cancers. Although PTC generally has a good prognosis, some patients suffer from local recurrence and/or distant metastasis. Oncogenes have reported to be related not only in carcinogenesis but also in tumor prognosis, tumor type, differentiation and site of tumor in epithelial malignant tumors such as thyroid, breast, ovarian, and stomach cancer. This study was planned retrospectively and was performed in 87 patients (47 PTC, 40 benign lesions). The data of clinicopathologic parameters and tissue samples were collected from the archives. Sections stained with H&E were evaluated for each case and after confirming the diagnosis of PTC, oncoprotein expressions were determined by immunohistochemical analysis. The differences of oncoprotein expressions in PTC compared with control group were statistically significant. Cyclin D1 and p53 expressions were significantly increased in PTC. The expressions of bcl-2 and c-erbB-2 in PTC were found as increased, but the correlation between these proteins and poor prognostic parameters were not significant. We suggest that increased expressions of cyclin D1 and p53 could be used as prognostic factors in patients with PTC.
No preview · Article · May 2011 · Medical Oncology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to present preliminary resul ts of our experience about laparoscopic cholecystectomy through single intraumbilical incision. Five patients who underwent cholecystectomy with the method of singl intraumbilical incision at the Department of General Surgery of Gulhane Military Medical Faculty Haydarpasa Teaching Hospital between August 2009 and November 2009 were evaluated regarding age, gender, body mass index, amount of hemorrhage, rate of conversion to conventional lparoscopic surgery, duration of operation, duration of hospitalization and complications. There were no intraoperative or early postoperative complications and no conversion to conventional laparoscopic surgery. Mean amount of hemorrhage was less than 50 cc, mean duration of operation was 122.6 minutes, and mean duration of hospitalization was 1.2 day. The preliminary results of our experience about single incision laparoscopic surgery show this method is a good alternative to conventional laparoscopic surgery with better cosmetic results.
No preview · Article · Jan 2011 · Gulhane Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Sepsis remains a serious clinical problems resulting in high morbidity and mortality. We aimed to investigate the inflammatory
response in a septic rat model treated with immunomodulator agents. We used the cecal ligature and puncture model to establish
septic peritonitis in rats. Male Wistar-Albino rats were randomized into groups of seven rats each and assigned different
regimens: Tacrolimus 1 mg/kg/day, cyclosporin-A 5 mg/kg/day and methylprednisolone 15 mg/kg/day. These immunsuppressive agents
were applied at the 6 and 48 hour intraperitoneally. The animals were euthanized after 6 and 48 hours and systemic parameters
including, IL-2, IL-6, TNF-a, CRP, AST and creatinine were examined. Our study demonstrated that the experimental peritonitis
model caused a meaningful rise in the values of systemic parameters. This was especially apparent for early-applied cyclosporin
A; in addition, tacrolimus significantly decreased the levels both at the 6 and 48 hour. The excess immune response in complex
sepsis treatment might be restrained using immunosuppressive agents administered early. Although additional supportive, comprehensive,
experimental and clinical studies are still needed, this therapy model may prove to be an alternative for the future.
KeywordsInflammatory response-Immunosuppressive agents-Cyclosporine-A-Tacrolimus-Methylprednisolone
No preview · Article · Dec 2010 · Central European Journal of Medicine
[Show abstract][Hide abstract] ABSTRACT: Objective: We aimed to investigate the effects of enteral immunonutrition and Total Parenteral Nutrition (TPN) on the immune system and acute inflammatory response of patients who underwent major abdominal surgery.Material and Methods: Sixty gastric or colorectal cancer patients were randomized into two groups. Enteral immunonutrition was given to the first group and TPN was given to the second group. Albumin, prealbumin, retinol binding globulin (RBP), transferrin, IL-2, IL-6, CRP and T-Lymphocyte levels were determined for nutritional state and immunologic evaluation. Also, postoperative complications, postoperative intensive care unit (ICU) and hospital stays were compared between the two groups.Results: All nutritional parameters were significantly decreased on the postoperative first day in both groups. RBP and prealbumin levels significantly increased in Group I on postoperative day 5. IL-6 and CRP levels increased significantly in both groups. IL-2 levels increased significantly in Group I, T-lymphocyte percentage decreased significantly in Group II on postoperative day 1 and 5. The length of ICU and hospital stays were longer and postoperative infection rate was less in Group II.Conclusion: Decrease in severity of acute inflammatory response and postoperative infection rate, augmentation in cellular immunity, decrease in the length of ICU and hospital stay were observed in the enteral immunonutrition group after major abdominal surgery.
Full-text · Article · Dec 2010 · Medical Journal of Trakya University / Trakya Universitesi Tip Fakultesi Dergisi
[Show abstract][Hide abstract] ABSTRACT: Aim The E-cadherin/catenin complex plays an important role in epithelial tissue architecture. Decreased expression of cell adhesion molecules (E-cadherin, α-, β- and γ-catenin) have been reported to correlate with invasive behaviour. The aim of this study was to investigate the relation between the expression of adhesion molecules and clinicopathological characteristics and survival in colorectal carcinoma.
Method The expression of adhesion molecules were studied by immunohistochemistry in 138 colorectal carcinomas.
Results The mean age of the patients was 65 years (range: 21–89 years). In primary carcinomas, a reduction in membranous expression of E-cadherin, α-catenin, β-catenin, γ-catenin was demonstrated (70%, 68%, 73%, 77%, respectively). Nuclear expression of β-catenin was found in eight (5%) patients. Decreased membranous β- and γ-catenin expression significantly correlated with tumour differentiation (P = 0.013, P = 0.03, respectively). There was a significant association between advanced stage of the tumour and decreased membranous α-catenin expression (P = 0.012). Decreased E-cadherin and β-catenin membranous expression correlated with short survival following curative resection of the primary tumour (P = 0.04, P = 0.03, respectively).
Conclusion The decreased membranous expression of E-cadherin and β-catenin and increased cytoplasmic expression of β-catenin might be used as a prognostic marker to monitor patients with colorectal cancer.
No preview · Article · Nov 2010 · Colorectal Disease
[Show abstract][Hide abstract] ABSTRACT: Early diagnosis of acute appendicitis, known as the most frequent cause of acute surgical abdominal pathologies, dramatically decreases the related complications. D-lactate, produced by intestinal bacteria as a fermentation product, may be useful in diagnosing acute abdominal pathologies. The aim of this study was to investigate whether the presence of d-lactate would be a significant indicator in the early diagnosis of acute appendicitis.
Eighty consecutive patients were prospectively included in this study. The patients were divided into four groups: acute appendicitis (group 1), perforated acute appendicitis (group 2), nonspecific abdominal pain (group 3), and acute abdomen other than acute appendicitis (group 4). For the control group, blood samples were taken in the same manner from 20 healthy subjects.
There was no significant difference in blood d-lactate levels between the simple acute appendicitis and acute perforated appendicitis groups (p > .05). The blood d-lactate levels in groups 1 and 2 were significantly higher than those in groups 3 and 4, and the control group (p < .001). The reliability of d-lactate was determined as 97% sensitivity, 93% specificity, 90% positive predictive and 95% negative predictive values, and 95% accuracy.
Based on findings in this study, blood d-lactate level may be a valuable diagnostic marker for the diagnosis of acute appendicitis.
No preview · Article · Aug 2010 · Journal of Investigative Surgery
[Show abstract][Hide abstract] ABSTRACT: The intent of our study was to compare the effects of dexmedetomidine versus midazolam on perioperative hemodynamics, sedation, pain, satisfaction and recovery scores during colonoscopy.
A total of 60 ASA I-II patients, between 20 and 80 years of age were included in the study. Patients were randomly assigned to two groups. Midazolam 0.05 mg kg(-1) and fentanyl citrate 1 microg kg(-1) were administered intravenously to cases in Group I (n = 30). An initial loading dose of 1 microg kg(-1) dexmedetomidine was administered intravenously in 10 min to cases in Group II (n = 30) before the procedure and as a continuous infusion dose of 0.5 microg kg(-1) h(-1) just before the procedure started. Also 1 microg kg(-1) fentanyl citrate was administered intravenously immediately before the procedure. Peripheral oxygen saturation (S(pO2)), mean arterial pressure (MAP), heart rate (HR), Ramsay Sedation Scale (RSS), Numeric Rating Scale (NRS) scores and colonoscopist satisfaction scores of the cases were recorded.
Although statistically significant values were not detected between the two groups with regard to mean arterial pressure, in Group I heart rates were higher and S(pO2) scores were lower in a statistically significant manner. When the groups were compared with regard to RSS, the RSS scores of Group I at the 10th and 15th minutes were significantly lower than Group II. There was no statistically significant difference between the two groups when compared with regard to NRS scores. Satisfaction scores were significantly lower in Group II.
Dexmedetomidine provides more efficient hemodynamic stability, higher Ramsay sedation scale scores, higher satisfaction scores and lower NRS scores in colonoscopies. According to our results we believe that dexmedetomidine can be used safely as a sedoanalgesic agent in colonoscopies.
No preview · Article · Jul 2010 · European Journal of Anaesthesiology
[Show abstract][Hide abstract] ABSTRACT: Objective: The most important complication following colorectal surgery is the anastomotic leakage. The aim of this study was to investigate the protective effect of thermal preconditioning and preoperative warming in the short and long term manner on anastomotic healing as well as to compare these two procedures to find out which is superior. Material and Methods: Forty-eight Wistar rats were randomly assigned into six groups, each consisting of 8 rats. The groups were formed as short (3 days) and long (7 days) term anastomoses (control), short and long term thermal preconditioning, and short and long term preoperative warming groups. Anastomotic healing was assessed on postoperative day 4 and 7 by determining anastomotic bursting pressure, tissue hydroxyproline content and histopathological examination. Results: The hydroxyproline levels were significantly higher in long term than those of short term (p=0.01). While preoperative warming had no effect on the hydroxyproline levels in short term, they were significantly higher in thermal preconditioning (TP) group than those of preoperative warming (PW) (p=0.01). In addition, the long term bursting pressures were found to be increased in all groups (p=0.01, for three groups) without any significant differences between groups both in short and long terms. Neither TP nor PW did affect the fibrotic index in STA and LTA groups. Conclusion: Colonic anastomoses performed with thermal preconditioning technique, increase the collagen synthesis on the anastomosis line in the early period of healing, and it is obvious that this technique could contribute to the anastomosis stability. Although the other parameters do not support our opinion, we believe further experiments about optimum heat and time would be a guide.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic splenectomy (LS) is becoming the "gold standard" technique for splenectomy. The aim of this study was to evaluate the hospital experience, body image, and cosmesis after LS or open splenectomy (OS).
Patients who underwent LS or OS were invited to fill out questionnaires evaluating their hospital experience, body image, and cosmetic results. A total of 72 patients (34 LS and 38 OS) agreed to participate in the study.
No significant difference was observed between the groups in terms of age, sex, body mass index, or indication for splenectomy. Mean spleen weight and postoperative complications were slightly higher (P>0.05) and the postoperative hospital stay was significantly longer (P<0.05) in the OS group compared with the LS group. Scores from the modified Body Image, Hospital Experience, and Photo Series Questionnaires were higher (favorable) in the LS group compared with the OS group (P<0.01, P<0.001, and P<0.001, respectively).
LS is the procedure of choice for most indications of splenectomy, which has comparable or better perioperative outcomes and complication rate as well as the advantages of better body image, cosmesis, and hospital experience compared with OS. Our results presenting improved outcomes with LS will contribute to the widespread application of laparoscopy for splenectomy.
[Show abstract][Hide abstract] ABSTRACT: The two most common procedures for open tension-free groin hernia repair with prosthetic mesh are the Lichtenstein operation and the mesh plug (Rutkow-Robbins) technique. Our study evaluated these two techniques on testicular blood flow and volume, and sperm function in young adults.
We randomized operation types with a systematic sampling method, and handled consecutive patients of age 20-30 years having unilateral inguinal hernia repair at our institution from March to August 2008. The study subjects were divided into the Lichtenstein group (LG) and the mesh plug group (MPG). All subjects received color Doppler ultrasonography to determine testicular volume and resistive index (RI) the day before surgery and 3 months postoperatively by a physician blinded for the type of planned or performed operation. Spermiograms done preoperatively and at 3 months postoperatively measured sperm concentration and the rate of progressive motility.
Sixty-four patients met the study criteria, with 32 patients each in the LG and MPG. RI levels were elevated postoperatively in both the LG (P = 0.027) and MPG (P = 0.012); there was no significant alteration in terms of testicular volume and spermiogram in the LG and MPG.
The Lichtenstein and mesh plug techniques in unilateral inguinal hernia increase the RI level significantly in the early postoperative period, but do not have a significant effect on sperm concentration and the rate of progressive motility.
[Show abstract][Hide abstract] ABSTRACT: Minimally invasive techniques, such as laparoscopic appendectomy (LA), are thought to produce better cosmetic results. The aim of this study was to evaluate the body image and cosmesis of patients after both LA and open appendectomy (OA).
Between August 2007 and June 2008, patients who underwent LA or OA with the diagnosis of acute appendicitis were invited to participate in the study by filling out the body image questionnaire. Patients with OA who had the Rockey-Davis incision and LA patients who had the operation by 3 trocars (10-mm infraumbilical, 5-mm suprapubic and additional 10 mm left lower quadrant), were included in the study.
A total of 38 patients (20 LA, 18 OA) participated in the study. The mean incision size for OA was 3.2 cm (range, 2 to 6 cm), and the mean scores from the body image questionnaire (both body image scale and cosmetic scale) were similar for both groups (P>0.05). No significant complications or changes in self-confidence (preoperative vs. postoperative) were observed in either group (P>0.05).
To our knowledge, there is no study in the literature that evaluates body image and cosmesis using objective methods for LA. Our results showed that LA has no advantage for body image and cosmesis over OA. Furthermore, prospective studies using different tools with a larger sample size are needed to rationalize the use of laparoscopy for appendectomy.
[Show abstract][Hide abstract] ABSTRACT: A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.
[Show abstract][Hide abstract] ABSTRACT: Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC).
To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival.
The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival.
Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival.
The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.
[Show abstract][Hide abstract] ABSTRACT: In this study it was aimed to evaluate the comparative results of different surgical techniques used in elective splenectomy on the basis of our particular experience and patient series. The medical records of patients undergoing elective splenectomy in a 8-year period were investigated ret-rospectively. The patients were divided into open (n=87), laparoscopic (n=17) and hand-assisted laparoscopic splenectomy (n=11) groups, and these groups were compared with respect to demographic data, body mass index, indication for splenectomy, size of the spleen, duration of operation, rate of conversion to open surgery, and major and minor complications after surgery. It was detected that hand-assisted laparoscopic splenectomy was performed in larger spleens. Only two of the 11 patients had idiopathic trombocytopenic purpura in the hand-assisted laparoscopic splenectomy group, whereas the major cause of splenectomy in other groups was idiopathic trombocytopenic purpura. Conversion to the open surgery was seen in one patient in each of the two laparoscopic groups, and relaparotomy was performed in one patient in each of the open surgery and hand-assisted laparoscopy groups. There were 5 minor surgical complications in the open surgery group, and one in each of the other groups. In conclusion hand-assisted laparoscopic splenectomy which was more preferred in patients with large sized spleens has shortened the operation time. Laparo-scopic splenectomy and hand-assisted laparoscopic splenectomy are safe surgical procedures with acceptable complication rates.
No preview · Article · Jan 2009 · Gulhane Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Objective: This study was designed to assess the prognostic value of lymph node ratio (LNR) in patients with nonmetastatic colorectal cancer treated with radical resection. Material and Methods: The characteristic and pathologic parameters of 280 patients operated on for nonmetastatic colorectal cancer at our service were recorded retrospectively. Patients were stratified into 4 groups according to the LNR quartiles of 1/12, 1/4, 1/2 and 1. Distribution of demographic data and probability tables were made by ANOVA and chi(2) tests. The cumulative survival ratios for LNR, N stage and TNM stage were calculated by the Kaplan Meier method and survival difference between groups were calculated by the log rank test. Results: There was a statistically significant correlation ratio between metastatic lymph node count and LNR. In 173 of all patients (61.8%) fewer than 12 lymph nodes were harvested. One hundred sixtysix (59.3%) patients were evaluated as NO, 79(28.2%) were N1 and 35(12.5%) were N2. The number of patients in 4 groups of LNR were 174 (621%), 72(25.7%), 22 (7.9%) and 12 (4.3%) respectively. Five year survival ratios were 82,8% in LNR1, 69.4% in LNR2, 58.3% in LNR3 and 50% in LNR4. The difference for survival times and ratios between these groups were significantly difference (p=0.001). Conclusion: LNR may help physicians to decide the adequate treatment and estimate the prognosis in patients with inadequate lymphadenectomy.
Full-text · Article · Jan 2009 · Medical Journal of Trakya University / Trakya Universitesi Tip Fakultesi Dergisi