Ali Rıza Tümer

DROPPED GALLSTONES DURING LAPAROSCOPIC CHOLECYSTECTOMY: THE CONSEQUENCES

During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences.

Effects of different types of soil on decomposition: An experimental study

Decomposition, a postmortem process including autolysis and putrefaction, is affected by many factors (e.g., humidity, microbial activity, soil properties). The purpose of this study was to determine the importance of soil type in decomposition process. Changes occurred in two intervals (3 and 6 months) were evaluated using a total of 32 Sus scrofa limbs by burying in four different types of soil (loamy, clayey, sandy and organic). The extremities in all soils had lost weight over time; however, mass loss was greater in loamy and organic soils in both intervals. Entomological findings were also assessed. Obtained findings of soil analysis and evaluation of decomposition were compatible. In conclusion, the present study revealed that soil properties and textures should be taken into account in evaluation of decomposition and estimating postmortem interval in crime scene investigation.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Measurement of ethyl glucuronide in vitreous humor with liquid chromatography–mass spectrometry

BACKGROUND It is important to detect alcohol intake in postmortem investigations. However it can be difficult to interpret the results of alcohol analysis in putrefied corpses. To avoid this difficulty, there have been studies on detection of ethyl glucuronide (EtG), a non-oxidative metabolite of ethyl alcohol. The aim of this study was investigate EtG levels in vitreous humor (VH), a valuable material in postmortem investigations, and to compare VH EtG levels with blood and urine EtG levels. METHODS Blood, urine and VH specimens were collected from 110 cases. Twenty-four cases in which ethyl alcohol was detected were included in the study. Although ethanol could not be detected, one case was added after having positive results of EtG levels in urine and VH as if he was claimed that he was an alcoholic and he had taken alcohol when he died but it could not be detected after 6 days of hospitalization. Liquid chromatography-mass spectrometry was used to investigate EtG in blood, urine and VH specimens from 25 cases. RESULTS AND CONCLUSION VH EtG was in measurable amounts in 19 cases (n: 25). In fact, VH EtG levels ranged from 0.05 to 1.90 mg/L and were below the limit of detection (LOD is 0.03 mg/L) in six cases (n: 25). Blood EtG was in measurable amounts in 21 cases (n: 25). Blood EtG levels ranged from 0.64 to 5.82 mg/L and were below the limit of detection (LOD is 0.083 mg/L) in four cases. EtG was detected in urine in 17 cases (n: 19). Urine EtG levels ranged from 0.25 to 623 mg/L and were below the limit of detection (LOD is 0.12 mg/L) in one case. There was a significant relation between VH EtG levels and blood and urine EtG levels. The results of the study showed that postmortem VH EtG can be measured to reveal alcohol intake.

Effects of 5-fluorouracil and zinc on healing of colonic anastomoses in rabbits.

OBJECTIVE To find out if 5-fluorouracil (5-FU) given intraperitoneally to rabbits impaired the healing of colonic anastomoses, and whether giving zinc might reverse the effect. DESIGN Laboratory study. SETTING Teaching hospital, Turkey. ANIMALS 32 New Zealand white rabbits. INTERVENTIONS All animals had 1cm of large bowel resected 10cm proximal to the peritoneal reflection and continuity restored by end-to-end anastomosis. They were divided into four groups and given intraperitoneal injections of saline (control group), 5-FU 10mg/kg/day in a concentration of 5mg/ml saline (5-FU alone group), zinc 2mg/kg/day (zinc alone group), and the same doses of 5-FU and zinc (5-FU + zinc group). The injections were given immediately after operation and daily for 4 days. The rabbits were killed at 7 days. MAIN OUTCOME MEASURES Bursting pressures, tissue hydroxyproline concentrations, tissue zinc concentrations, and light and electron microscopic appearances. RESULTS Six rabbits died of the complications of anaesthesia and 4 of sepsis leaving 7, 6, 7, and 6 rats in the four groups respectively. Mean (SD) anastomotic bursting pressures were significantly reduced in the 5-FU group compared with controls (5 (2) compared with 7 (1) mm Hg, p: 0.05) and collagen synthesis (indicated by reduced tissue hydroxyproline concentrations) was also decreased (7.1 (0.9) compared with 9.1 (1.5), p < 0.05). Rabbits given 5-FU + zinc had significantly higher bursting pressures than those given 5-FU alone (9 (2) compared with 5 (2), p: 0.01). Bursting pressures were also significantly higher in those given zinc alone, but hydroxyproline concentrations were similar to those in the control group. Histological examination showed that 5-FU alone significantly impaired the healing process, and those in the 5-FU + zinc group healed better than those in the 5-FU alone group. CONCLUSIONS 5-FU given intraperitoneally significantly impaired the healing of colonic anastomoses in rabbits, and zinc reversed this effect.

Munchausen by Proxy Syndrome: A Case Series Study from Turkey

Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a caregiver deliberately exaggerates, fabricates, and/or induces health problems in those in their care. The condition is extremely difficult to characterize and diagnose, as it manifests in many forms, often confusing the medical team. Insufficient knowledge regarding the syndrome and rare consideration of the differential diagnosis results in failure to recognize the problem. Literature suggests that an increase in physician awareness of the disorder can prevent or reduce its morbidity and mortality. For this reason, we believe that case series can help increase current knowledge on epidemiology, aetiology, diagnostic criteria, advised management of MSBP, and the psychological portrait of the perpetrator. Additionally, no data from Turkey has previously been presented on this issue. This study aimed to report characteristics of MSPB victims and alleged perpetrator, which were diagnosed and managed by a multidisciplinary team.

Medical forensic examination of detained immigrants: is the Istanbul Protocol followed?

Introduction Maltreatment and torture during custody is still an important problem in many countries. Both national and international regulations and the Istanbul Protocol are of great importance in terms of elimination of maltreatment and torture. In this study, we evaluated whether examinations for custody of immigrants were performed in accordance with the Istanbul Protocol. Method We retrospectively evaluated reports of forensic examinations for custody of 100 immigrants in Van-çaldıran Government Hospital in 2009. Data about nationality, age, gender, examination date, referring department, examination findings and departments to which the reports were submitted were collected. Results Fifty percent of the immigrants were Iranian and they were aged between 11 and 62 years. Ninety-nine immigrants were men and one was woman. Data about history of arrest were missing in forensic reports about all immigrants. Data about signs of trauma were present only for seven immigrants. Ninety-three immigrants were reported to have no signs of trauma. None of the immigrants underwent psychiatric examination. All forensic reports were found to be submitted to the police personally. Whether the immigrants were examined before or after the custody was not clear in the reports. Conclusion Evaluation of the data showed that none of the forensic examinations were performed in accordance with the Istanbul Protocol. It can be recommended that the protocol should be incorporated into the curricula for undergraduate, graduate and in-service training programmes in order to improve relevant forensic practices.

Cerrahide aydınlatılmış onam ile ilgili sorunlar ve çözüm önerileri

GİRİŞ Aydınlatılmış onam; bireyin kendi bedenine yapılacak olan her türlü tıbbi uygulamayı bilmeli ve belirleme hakkına sahip olduğu görüşünü temel alan ve kişinin hastalık anında da kişilik haklarını koruyabilmek için bu konuda düzenlenmiş yasalarla güvence altına alınmış olan, başlarda bir öğretiden ibaret iken tarihi gelişimiyle birlikte uyulması zorunlu hale gelen bir kavramı ifade etmektedir.

Importance of informed consent defined by General Surgery Associations in Turkey

Objective Informed consent is a term based on the idea that every individual has the right to know every medical intervention that is going to be performed on their own body and to learn the issues that she/he may encounter in case of refusal of intervention, and it also defines the protection of personal rights under the guarantee of law. Material and Methods The website of Turkish Surgical Association and 25 different websites of surgical associations were evaluated according to general surgery association guide, which was published by the Turkish Surgical Association in 2011. Results Four websites of those surveyed include informed consent sections and these were evaluated. A total of 44 informed consent forms were included in this study. Of these, 29 were in Turk Colon and Rectum Surgery Association, 8 were in Turkish Surgery Association, 5 were in Turk Hepatopancreaticobilier Surgery Association, and 4 were in Endocrine Surgery Association. These informed consent forms were evaluated with regard to the aforementioned criteria. The results and also the distribution according to the associations were summarized. A common feature of the informed consent forms was that all of them included the risks of the intervention/operation and complications to be carried out. On the contrary, none of them included approximate time of surgery, information about surgeons, issues that patients should care about before surgery, the section that permits the use of data for scientific purpose, and the time of signing the informed consent form. Conclusion We believe that in this context the regulation of informed consent by sub-specialization associations under the flag of Turkish Surgical Association is a very important matter and will standardize informed consents; websites of the associations will be easier to access, and this will be as beneficial for physicians as the patients and also will protect the physicians in probable trials.

Kırım Kongo Kanamalı Ateşi Olgularında Postmortem İncelemelerde Enfeksiyondan Korunma

SUMMARY Unless post-mortem examinations are perfomed in adequate circumstances, there may be some life-threatening infectious risks for both the forensic medicine staff and for the environment. In last few years there was an increasing number of deaths due to the Crimean-Congo hemorrhagic fever in Turkey. We aimed to observe the rules that should be followed to minimize the risks of the autopsy on Crimean-Congo hemorr