[Show abstract][Hide abstract] ABSTRACT: The incidence and subsequent outcomes of missed injuries and the primary factors contributing to each missed injury were analyzed.
Records of 709 trauma patients were reviewed between December 2003 and December 2004. Demographic data were compared and analyzed for two patient groups: those with multiple injuries diagnosed in 24 hours and those with multiple injuries diagnosed in >24 hours.
Fifty-two missed injuries were determined in 34 (4.8%) patients. There were significant differences between the patients with and without delayed diagnoses, including the mean injury severity scores (23 vs. 16.9), morbidity, and mortality (p < 0.05 for all). Among 69 contributing factors identified, 28 (40.6%) were unavoidable and 41 (59.4%) were potentially avoidable.
Missed injuries could usually be encountered in the most seriously injured patients, particularly in those with altered levels of consciousness. Missed injuries were mostly avoidable and most were the result of inadequate clinical examination.
Full-text · Article · Jul 2006 · Military medicine
[Show abstract][Hide abstract] ABSTRACT: We aim to present primary retroperitoneal lymphocele, which is very rarely reported in the literature, as an entity to be considered in the differential diagnosis of retroperitoneal masses. Clinical and radiological findings, with the management of primary retroperitoneal lymphocele, which did not occur as a complication of previous surgery, are presented. A 20 years old male patient presented with abdominal pain. History revealed that he had been operated on four years previously after a diagnosis of retroperitoneal mass. Following histopathologic examination of specimens from excisional biopsy and aspiration of the mass, a lymphocele was diagnosed. Similarly following abdominal ultrasound and computed tomography, a retroperitoneal lymphocele was diagnosed. Ultrasound guided drainage of the lymphocele was performed, however, on recurrence, the mass was totally excised. Total surgical excision of lymphocele is the preferred method of treatment, rather than aspiration, percutaneous drainage and sclerotherapy, because it has the lowest rate of recurrence.
No preview · Article · Jan 2006 · Erciyes Tip Dergisi
[Show abstract][Hide abstract] ABSTRACT: Octreotide, a long-acting somatostatin analogue, has been used in the treatment of various disorders. Octreotide has significant detrimental impacts upon wound healing. We tested the hypothesis that hyperbaric oxygen therapy may overcome octreotide-mediated suppression of wound healing.
Prospective, randomised, parallel-group animal study.
Operated rats were divided into four groups: (1) controls, (2) octreotide therapy, (3) hyperbaric oxygen therapy and (4) combination of octreotide and hyperbaric oxygen therapy. Wound healing was assessed by breaking-strength measurements, hydroxyproline levels and fibrosis scores.
Octreotide decreased the breaking-strength measurements, hydroxyproline levels and fibrosis scores to 72%, 88% and 55%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy increased breaking-strength measurements and hydroxyproline levels to 137% and 126%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy tended to increase the fibrosis scores to 111% of the control group, but without statistical significance.
Hyperbaric oxygen therapy tends to reverse the octreotide-induced impairment of wound healing.
No preview · Article · Jun 2004 · European Journal of Gastroenterology & Hepatology
[Show abstract][Hide abstract] ABSTRACT: Appendiceal mucocele is a rare clinical condition that causes distension of the appendix lumen with mucus. A seventy-three-year-old female patient presented with complaints of abdominal pain, nausea, and vomiting. Abdominal examination revealed mild tenderness, right lower quadrant pain upon palpation, rebound tenderness and muscular rigidity, and a palpable mass. Abdominal ultrasonography and computed tomography scans demonstrated a cystic lesion in the right iliac fossa, adherent to the cecum, suggesting an abdominal abscess. An emergency operation was performed, during which a diagnosis of a mucocele of the appendix was made. Surgical treatment included appendicectomy, partial resection of the ileum, and resection of the cecum. Histopathologic examination confirmed the operative diagnosis. The role of imaging and clinical approach is emphasized in the treatment of an appendiceal mucocele, especially in emergency settings.
Full-text · Article · Feb 2004 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: Tamoxifen is being used successfully in breast cancer patients as adjuvant hormonal therapy. The aim of this retrospective cohort study is to evaluate the impact of tamoxifen on gallstone formation in postmenopausal breast cancer patients. A total of 3165 patients who were treated for invasive breast cancer between 1990 and 1997 were reviewed. The data were collected from four university hospitals in a population-based registry. Among these patients, 2462 were excluded from the study owing to improper follow-up and other reasons. Premenopausal patients were also excluded. Of the 703 patients included in the study, 457 had received adjuvant therapy including tamoxifen, and the other 246 had not. Gallstone formation was assessed by annual abdominal ultrasonography. The mean follow-up period was 4.6 years (range 1-7 years). There were no significant differences between the groups of breast cancer patients treated with or without tamoxifen regarding the age of the patients at the time of breast cancer diagnosis, the age at menopause, the duration between the onset of menopause and the time the breast cancer was diagnosed, the presence of diabetes, and the body mass index. At the end of 5 years the incidence of gallstone formation in tamoxifen-treated patients was 37.4%, whereas it was 2.0% in patients who did not receive tamoxifen ( p < 0.0001). The incidences of gallstones being detected in 171 tamoxifen-treated patients were 0.4%, 3.7%, 24.4%, 33.1%, and 37.4% cumulatively during the first, second, third, fourth, and fifth years, respectively. Hence adjuvant tamoxifen therapy leads to gallstone formation in postmenopausal breast cancer patients and is most apparent after 3 years of treatment.
No preview · Article · Apr 2003 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: This study investigates the effects of hyperbaric oxygen (HBO2) therapy on the healing capacity of colonic anastomoses under the influence of preoperative chemotherapy.
Forty male Wistar-Albino rats were divided into four groups of 10. Colonic resection and anastomosis were performed in each group. Group I (control) received no further treatment. In group II, 5-fluorouracil was administered intraperitoneally for five consecutive days preoperatively. Group III received HBO2 therapy for seven days after the anastomosis. Group IV received HBO2 therapy following the administration of preoperative 5-fluorouracil. On the seventh postoperative day, all the rats were examined to determine the bursting pressures of the anastomosis and to take tissue sample from the anastomotic line for hydroxyproline measurement.
Bursting pressures of the anastomosis in group IV were increased significantly compared to group II. Hydroxyproline levels were significantly increased with the use of HBO2 in rats, independent of chemotherapy administration.
HBO2 therapy strengthens anastomoses created under the influence of neoadjuvant chemotherapy. This technique might have a future role in the care of colon cancer patients undergoing new multimodality cancer treatments.
Full-text · Article · Feb 2003 · Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to demonstrate bacterial translocation after experimentally induced intestinal obstruction as well as investigate the preventive effects of hyperbaric oxygen on obstruction-induced bacterial translocation in rats.
Forty Wistar-albino male and female rats were used. Although no procedure was done in the control group (n = 8), hyperbaric oxygen treatment under 2.5 atm absolute for 90 minutes daily was applied for two days in the hyperbaric oxygen group (n = 8). In the sham group (n = 8), after laparotomy the small bowel was only handled gently, and tissue sampling was done 48 hours later. In the obstruction group (n = 8) the ileum was ligated by 5-0 polypropylene just 5 cm proximal to the ileocecal valve. In the obstruction and hyperbaric oxygen group (n = 8), after obstruction hyperbaric oxygen treatment was applied. Forty-eight hours after the procedures, tissue samples from small bowel, mesenteric lymph nodes, spleen, and liver were taken and 1 ml of blood from the portal vein was withdrawn. All samples were cultured for microbiologic examination.
Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine of normal rats. Endogenous bacteria in the small intestine were significantly increased in the obstruction group, and the presence of bacterial overgrowth was proven by bacterial presence on mesenteric lymph nodes, spleen, liver, and blood. Hyperbaric oxygen treatment significantly reduced the endogenous bacterial overgrowth in the small intestine and prevented the bacterial translocation almost completely in obstruction-induced rats.
Intestinal obstruction causes bacterial overgrowth and translocation. Hyperbaric oxygen treatment prevents the bacterial translocation effectively.
No preview · Article · Aug 2002 · Diseases of the Colon & Rectum
[Show abstract][Hide abstract] ABSTRACT: This study was designed to investigate therapeutic effects of hyperbaric oxygen on experimentally induced colitis in rats by assessing oxidative tissue damage, neutrophil accumulation and histological changes. Six groups of animals were used. No procedures were done in the sham group. In the vehicle group, 50% ethanol-induced colitis, and in four other groups, 2,4,6-trinitrobenzene sulphonic acid-induced colonic inflammation was achieved. In acute and chronic colitis non-treatment groups, no other procedure was done. In acute and chronic colitis hyperbaric oxygen treatment groups, rats underwent hyperbaric oxygen treatment for two or fourteen days. On the third and fifteenth days respectively tissue and blood samples were taken for microscopic and macroscopic damage assessment, myeloperoxidase activity and serum carbonyl content measurements. There was significant colonic tissue damage in non-treatment groups at 48 hours and 14 days. Hyperbaric oxygen treatment ameliorated the macroscopic damage significantly in chronic colitis. Amelioration of microscopic changes was not significant in each hyperbaric oxygen-treated group. Hyperbaric oxygen treatment significantly reduced tissue myeloperoxidase activity in acute colitis and decreased plasma carbonyl content in chronic colitis. In the present study, hyperbaric oxygen treatment significantly ameliorated trinitrobenzene sulphonic acid-induced chronic colitis in rats.
Full-text · Article · Feb 2002 · Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc
[Show abstract][Hide abstract] ABSTRACT: Although the recommended treatments of chronic anal fissure are anal dilatation and lateral internal sphincterotomy, which are successful in 85-90% of patients, these procedures permanently weaken the sphincter, which may be associated with incontinence, infection, and anal deformity. The aim of that study is to investigate the efficacy of alternative treatment methods such as nifedipine, glyceryl Seventy-five consecutive patients who applied to Department of Surgery with the diagnosis of chronic anal fissure between 1998 and 2000 were included in the study. Patients were divided into nifedipine (n=25), glyceryl trinitrate (n=25), and botulinum toxin (n=25) groups in a prospective randomised manner. Oral nifedipine 20mg daily for five days in nifedipine group, topical 0.2% glyceryl trinitrate ointment twice daily for 30 days in glyceryl trinitrate group, and a single injection of 25 unit botulinum toxin to internal anal sphincter in botulinum group were applied. The patient in each group were evaluated for their anal resting and squeeze pressures just before and 30 days after treatment, and for their physical signs and symptoms just before and 15 and 30 days after treatment. The resting anal pressures in all treatment groups were decreased significantly according to pre-treatment results (p<0.05). Patients' signs and symptoms were also diminished or disappeared significantly in all treatment groups. No major complication due to applications was detected. It is concluded that oral nifedipine, topical glyceryl trinitrate, and botilunum toxin injection may be alternative to surgical treatment and may diminish permanent complications due to surgical management.
[Show abstract][Hide abstract] ABSTRACT: New prognostic factors in gastric carcinoma to determine the prognosis of the disease or to identify patients who will benefit from adjuvant therapy are being researched. The aim of this study is to investigate the correlation between microvessel count (MVC) and various clinicopathologic features in gastric carcinoma in order to evaluate the role of angiogenesis on the prognosis of gastric cancer.
Fifty-seven patients who underwent surgical intervention for gastric carcinoma between 1993 and 1997 were reviewed retrospectively. The relationship between MVC and various clinicopathological features was assessed. The effect of angiogenesis on overall survival and the role of MVC and other prognostic factors on distant metastases were assessed by multivariate analysis. Microvessels were outlined by anti-factor VIII, which is a specific monoclonal antibody to factor VIII in vessel endothelial cells, using the streptavidin-biotin method and counted under light microscopy x200 magnification.
There was no correlation between MVC and age or sex of the patient, duration of symptoms or tumor size. Proximally located, undifferentiated, diffuse type, serosal invasion positive, lymph node invasion positive, advanced stage, or distantly metastasized tumors had higher MVCs. Higher MVCs affected the overall survival adversely. Lymph node metastasis, serosal invasion and MVC were found as independent prognostic factors affecting distant metastases. MVC was the sole factor affecting recurrent liver metastasis.
It is concluded that MVC in gastric carcinoma may be a valuable prognostic factor to predict patients at high-risk for possible recurrences and to decide on postoperative adjuvant therapy.
No preview · Article · Feb 2000 · Digestive Surgery