Aytekin Unlu

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence.

BackgroundPhenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods.MethodsIn this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined.ResultsThe mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05).ConclusionsInjection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases

Introduction Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. Method Participants from a training tank battalion were randomised. Data collected included age, body mass index, mean arterial pressure, hand dominance, femoral artery diameter and skin thickness. The study involved tourniquet application times (AT) and application success rates in basic, after-training and eyes-closed phases. Doppler ultrasound was used to identify the presence or absence of popliteal, radial and ulnar artery pulses. Results A total of 102 trainees participated. In the after-training phase, the left and right upper extremity ATs were 35±13.1 s, and 34.8±13.5 s and the right and left lower extremity ATs were 20.6±6.0 s and 20.5±5.5 s, respectively. The overall tourniquet success rates in three successive study phases were 69.6%, 82.4% and 91.2%, respectively. A negative significant relationship was found between extremity circumference and tourniquet success. Discussion The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.

Freezing of Apheresis Platelet Concentrates in 6% Dimethyl Sulfoxide: The First Preliminary Study in Turkey.

Objective: Transfusion of platelet suspensions is an essential part of patient care for certain clinical indications. In this pioneering study in Turkey, we aimed to assess the in vitro hemostatic functions of platelets after cryopreservation. Materials and Methods: Seven units of platelet concentrates were obtained by apheresis. Each apheresis platelet concentrate (APC) was divided into 2 equal volumes and frozen with 6% dimethyl sulfoxide (DMSO). The 14 frozen units of APCs were kept at -80 °C for 1 day. APCs were thawed at 37 °C and diluted either with autologous plasma or 0.9% NaCl. The volume and residual numbers of leukocytes and platelets were tested in both before-freezing and post-thawing periods. Aggregation and thrombin generation tests were used to analyze the in vitro hemostatic functions of platelets. Flow-cytometric analysis was used to assess the presence of frozen treated platelets and their viability. Results: The residual number of leukocytes in both dilution groups was <1x106. The mean platelet recovery rate in the plasma-diluted group (88.1±9.5%) was higher than that in the 0.9% NaCl-diluted group (63±10%). These results were compatible with the European Directorate for the Quality of Medicines quality criteria. Expectedly, there was no aggregation response to platelet aggregation test. The mean thrombin generation potential of post-thaw APCs was higher in the plasma-diluted group (2411 nmol/L per minute) when compared to both the 0.9% NaCl-diluted group (1913 nmol/L per minute) and the before-freezing period (1681 nmol/L per minute). The flow-cytometric analysis results for the viability of APCs after cryopreservation were 94.9% and 96.6% in the plasma and 0.9% NaCl groups, respectively. Conclusion: Cryopreservation of platelets with 6% DMSO and storage at -80 °C increases their shelf life from 7 days to 2 years. Besides the increase in hemostatic functions of platelets, the cryopreservation process also does not affect their viability rates.

Publication rates of abstracts presented at the annual congress of the Turkish Society of Colorectal Surgery (years 2003-2011)

OBJECTIVE The aim of our study is to examine the Publication Rate of Congress of Turkish Society of Colorectal Surgery meeting abstracts and determine the factors affecting publication rate. MATERIAL AND METHODS All presentations at Congress of Turkish Society of Colorectal Surgery congresses held in 2003, 2007, 2009, 2011 were retrospectively assessed. Manuscripts indexed in Google-Scholar database were included. The meeting year, study type, presentation type, title and time to publication of studies were assessed. Actual impact factor values were assessed to introduce the scientific power of the journals. RESULTS Among a total of 614 abstracts presented at these congresses, 139 (22.6%) presentations were published in various medical journals. The publication rate was higher in oral presentations as group compared to poster presentations (29.7% vs. 19.5%) (p<0.001). Mean time to publication period was 20.4 (±21.1) months. 78 (56.1%) of published articles were published in SCI-E journals while 61 (43.9%) were published in non-SCI-E journals. Experimental studies had a higher Publication Rate in analysis of publication rate according to study type (p<0.001). Prospective clinical studies had a higher publication rate than retrospective studies. The journals in which oral presentations had been published had greater impact factor than journals in which poster presentations had been published (p=0.02). If published; prospective clinical studies were published in journals with greater impact factor than retrospective studies (p=0.04). CONCLUSION The quality of a meeting is correlated with the publication of abstracts accepted as presentations. Congress of Turkish Society of Colorectal Surgery congress is an efficient meeting for researchers, and have a lower PR as compared to international congresses while having a similar publication rate to equivalent scientific meetings. Being more selective during abstract acceptance should increase the Publication Rate and quality of Congress of Turkish Society of Colorectal Surgery congresses.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma centers data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.

Bringing PRBC to the point of combat injury: are we there yet?

Objective Hemorrhage is the leading cause of injury-related prehospital mortality. We investigated worst-case scenarios and possible requirements of the Turkish military. As we plan to use blood resources during casualty transport, the impact of transport-related mechanical stress on packed red blood cells (PRBCs) was analyzed. Materials and Methods The in vitro experiment was performed in the environmental test laboratories of ASELSAN®. Operational vibrations of potential casualty transport mediums such as Sikorsky helicopters, Kirpi® armored vehicles, and the NATO vibration standard MIL-STD-810G software program were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (≤7 days) and 10 units of old (>7 days) PRBCs in a blood cooler box. The vibrations were simulated with a TDS v895 Medium-Force Shaker Device. On-site blood samples were analyzed at 0, 6, and 24 h for biochemical and biomechanical analyses. Results The mean (±standard deviation) age of fresh and old PRBCs was 4.9±2.2 and 32.8±11.8 days, respectively. Six-hour mechanical damage of fresh PRBCs was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), and supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), and supernatant hemoglobin (p=0.015) were increased and hematocrit levels were decreased (p=0.015) within 6 h. Two (13%) units of fresh PRBCs and none of the old PRBCs were eligible for transfusion after 6 h of mechanical stress. Conclusion When an austere combat environment was simulated for 24 h, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, the technology to overcome this mechanical damage does not seem to exist. In light of the above data, a new national project is being performed.

Platelet-rich plasma as an additional therapeutic option for infected wounds with multi-drug resistant bacteria: in vitro antibacterial activity study.

PurposeInfected wounds, such as diabetic foot infections, are mostly polymicrobial and microorganisms have high resistance rates to antimicrobials. Infected wounds in diabetic patients have high cost, morbidity, and mortality rates. Based on these facts, there is a need for supportive localized treatment options such as platelet-rich plasma (PRP) implementations. Demonstrating the in vitro antimicrobial effect, our aim was to lead up to clinical trials of localized PRP implementations in infected wounds such as diabetic foot infections. In this study, we aimed to demonstrate the in vitro antibacterial activity of PRP against methicilin-resistant Staphylococcus aureus (MRSA) and three more multi-drug resistant bacteria species that are important and hard-to-treat in wound infections.Materials and methodsIn vitro antimicrobial activity of autologous PRP, platelet-poor plasma (PPP), and phosphate-buffered saline (PBS) on methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., extended spectrum beta lactamase producing Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa was compared by assessment of bacterial growth on agar plates and antimicrobial susceptibility test results.ResultsWhen compared to control group, PRP and PPP significantly suppressed bacterial growth of MRSA, K. pneumoniae, and P. aeruginosa at 1st, 2nd, 5th, and 10th hours of incubation (p < 0.05). VRE was the only bacteria that PRP and PPP showed limited activity against. When compared to PPP, PRP showed higher activity against MRSA, K. pneumoniae, and P. aeruginosa. However, the differences between PRP and PPP were statistically significant only against MRSA and P. aeruginosa at the first hour of incubation.ConclusionsEmerging PRP and other platelet-derived products seem to be promising alternative tools besides antibiotic treatment, debridement, negative pressure wound therapy, hyperbaric oxygen therapy, and other treatment options for treating diabetic foot infections.

The effect of comorbidities on the survival of colorectal cancer in the older patients

Dear Editor: We read the recent article by Hamaker et al. [1] titled “Improved survival for older patients undergoing surgery for colorectal cancer between 2008 and 2011” published online in the International Journal of Colorectal Disease (doi: 10.1007/ s00384-014-1959-y) with great interest [1]. The authors evaluated the impact of an increased application of laparoscopic surgery for colorectal cancer in the Netherlands on overall survival. They concluded that especially for older patients, application of laparoscopy had an advantage for reducing the mortality rate; therefore, the usage of laparoscopy was offered whenever possible by allowing for further improvement of outcomes. When we read the article, we have wondered about a condition.We feel that clarification regarding the following detail would be beneficial. The physiological, the social, and the psychological conditions of the older people is not the same as the younger people even for the healthy persons [2]. For the older patients undergoing surgery, the risk of facing with the comorbidities is higher than younger patients. This condition diverts the health providers to evaluate the older patients particularly before the operation. Therefore, the estimation of survival with older patients undergoing surgery for colorectal cancer should be done with evaluation of comorbidities such as respiratory and cardiovascular problems [3]. Turrentine et al. have stated that coexisting health conditions as gangrene, ventilator usage, chronic obstructive pulmonary disease, hemiplegia, renal failure hypertension, dyspnea, and preoperative transfusion are the risk factors effecting the survival in older patients for morbidity and mortality [4]. We thought that during the evaluation of the survival for older patients undergoing surgery, these factors should be taken into account for improving the quality of older people’s surgical care.

Kidney Preserving Resection of Leiomyosarcoma with Reconstruction of Left Renal Vein: Case Report

Background: Leiomyosarcoma is a common retroperitoneal sarcomas mostly originating from muscles. Only about 5% of leiomyosarcomas arise directly from large blood vessels and more than 50% of cases originate from inferior vena cava. Primary leiomyosarcomas of renal veins are extremely rare (30 cases). Mostly diagnosed at advanced stages because of nonspecific clinical signs. Case: A 40-year-old woman was evaluated of a left retroperitoneal mass with severe back pain. CT scan revealed a left retroperitoneal mass 7 cm. in size adjacent to left renal hilum. During the operation; a multilobular, solid tumor in 7 x 6.5 x 3 cm size, surrounding the left renal vein was observed. Further dissection revealed that the tumor was originated from left renal vein wall. Total devascularization and partial left renal vein resection with tumor and end to end anastomosis was performed. Vascular outflow was confirmed with intraoperative and postoperative doppler examination. Pathology was reported as moderately differentiated leiomyosarcoma, originated from renal vein wall with tumor free resection margins and the patient was discharged with adjuvant chemoradiotherapy. Conclusion: Although the radical nephrectomy is the gold standard approach for malign tumors of the kidney, kidney preserving tumor free resection with vascular reconstruction is a feasible alternative followed by adjuvant chemoradiotherapy and close follow up. Kidney preserving tumor free resection with vascular reconstruction and followed by adjuvant chemoradiotherapy is a feasible alternative instead of radical nephrectomy.

Quality of Life After Anti-Reflux Surgery in Adults

Concepts of validity are of vital importance in the contemporary health care environment where outcome and Quality of Life (QoL) constructs are seen as relevant end points for evaluating the success of treatment and justifying continued intervention. QoL assessments, though sometimes subtle, have always played a central role in the therapeutic objectives of medicine. While the evaluation of surgical interventions focus primarily on outcomes, judgment regarding the success of the intervention should also take into account the functional, physiological, and social aspects of the disease and its treatment. Particularly, in chronic disease states, patients’ QoL may be the most important parameter in assessing the efficacy of surgical treatment.