Barlas Sulu

Effect of pregabalin on post-dural-puncture headache following spinal anesthesia and lumbar puncture

In this study, we aimed to investigate the effect of pregabalin on post-dural-puncture headache (PDPH). Forty patients who developed PDPH after spinal anesthesia or diagnostic and/or therapeutic lumbar puncture were divided into two groups and followed for 5 days. The first group received 150 mg/day oral pregabalin for the first 3 days, then 300 mg/day for a further 2 days. The second group received a placebo for the same length of time. Patient headaches were scored using the visual analog scale, and diclofenac sodium and pethidine requirements were recorded. Relative to the placebo group, the group administered pregabalin had significantly lower visual analog scale scores after the second day of treatment, and had significantly lower diclofenac sodium requirements. Our results indicate that pregabalin may be useful for the management of PDPH.

A rare ileal tumor causing anemia and intussusception: inflammatory fibroid polyp.

To the editor, A 41-year-old female patient with symptoms of severe abdominal pain, vomiting, diarrhea, rectal bleeding, and weight loss was sent to our endoscopy unit for a colonoscopy. The full blood count revealed hemogram 8.6 g/dL and hematocrit 28%. Colonoscopic investigation revealed a fragile and bleeding tumoral mass at the level of the cecum that obstructed the lumen completely (Figure 1a). At surgery, an ulcerated mass that localized at the final section of the ileum and invaginated to the colon was found. When the specimen was opened, an ulcerative 5-cm mass located 12 cm from the ileocecal valve was seen (Figure 1b). The histopathology evaluation of the specimen led to a diagnosis of inflammatory fibroid polyp (IFP) (Figure 2). Microbiological evaluation showed Actinomyces israelii in the tissue. The anemia recovered during postoperative follow-up.

Comparison of Meperidine Versus Hyoscine During Colonoscopy in the Elderly: A Prospective Randomized Study

BACKGROUND Colonoscopy is the gold standard in diagnosis of diseases of the colon. Sedation and antispasmodic agents are recommended during colonoscopy. Age is a limiting factor when the surgeon is deciding whether to use these medications or not. SUBJECTS AND METHODS One hundred twenty patients older than 65 years of age were randomized into two groups. The first group (n=60) received 2 mg of midazolam and 25 mg of meperidine intravenously. The second group (n=60) received 2 mg of midazolam and 20 mg of hyoscine N-butylbromide intravenously. The data collected were colonoscopy procedure time, time to cecum, visual analog pain scale, systolic blood pressure before and after the procedure, pulse, partial oxygen pressure, comfort of the endoscopist, the modified observers assessment of alertness/sedation scale, and morbidity. RESULTS Total colonoscopy and cecal reach times were shorter in Group 2 (19.58±4.82 minutes and 10.57±2.54 minutes, respectively) than in Group 1 (25.05±5.93 minutes and 13.78±3.37 minutes, respectively) (P<.001). The sedation score of Group 2 (4.52±0.50) was better than that of Group 1 (3.45±0.75) (P<.001). Nine patients (15%) in Group 1 experienced diaphoresis, temporary memory loss, or lip smacking. Three patients in Group 1 and 1 patient in Group 2 had hypoxia. Three patients in Group 1 had hypotension; this was seen in 1 patient in Group 2. One patient had perforation in Group 1. The visual analog scale score was 4.37±1.38, and the endoscopist satisfaction was 6.72±0.99 in Group 1, while these values were 3.95±0.81 and 7.75±0.89, respectively, in Group 2 (P>.05). CONCLUSIONS Use of midazolam and hyoscine N-butylbromide during colonoscopy is safe in the elderly and significantly reduces procedure time while increasing comfort for the endoscopist.

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture

OBJECTIVE Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. MATERIAL AND METHODS Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. RESULTS The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. CONCLUSION MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.

Rectosigmoid Tumor Causing Rectal Prolapse: Case Report

Rectal prolapse is believed to develop secondary to anatomical defects. Rectosigmoid tumors are rare causes of this condition. This must be kept in mind in patients with prolapse; colonoscopic examination is recommended and biopsy should be performed when necessary. In this case report, we present an elderly patient with rectal prolapse. The mass that precipitated the prolapse was biopsied and identified as adenocarcinoma. The cancer was treated and patient was discharged.

The Comparison of Four-Port, Two-Port Without Suspension Suture and Single Port Laparoscopic Cholecystectomy Results

BACKGROUND Single-port surgery has recently become popular, however, many surgeons have to use additional ports during the surgery due to difficulties. OBJECTIVES We performed two-port MCAP (with an additional port using a multi-channel device through the umbilicus) without a suspension suture in a group of patients. We compared the results of this technique to the LC and SILC techniques. MATERIAL AND METHODS A total of 90 patients with gallbladder disease were included in the study. LC (n = 30) and SILC (n = 30) were performed in two groups. The other group underwent cholecystectomy (MCAP) by using an additional 5 mm port through the subxiphoid region with a multi-channel port through the transumblical. A transabdominal suspension suture was not used for the patients in this group. The surgery duration, estimated blood loss, length of hospitalization, visual analogue scale (VAS) score in the postoperative 1st and 7th day, need for analgesia in the postoperative period and complications, and the conversion rate were compared between the three methods. RESULTS A total of 62 females (68.9%) and 28 males (31.1%) participated in the study. MCAP duration was significantly shorter than LC and SILC (38.1 ± 16.6, 49.4 ± 15.8, 77.8 ± 26.7 min respectively) (p < 0.05). The conversion rate was similar in all three groups. Hernia developed in the port area in two patients after SILC (6.7%). No significant difference was found between the groups for the other data we compared. CONCLUSIONS MCAP seems to be an easier technique with a shorter operation time compared to the other two techniques. However, there is a need for other studies to evaluate the cosmetic results.

Effects of alpha lipoic acid on intra-abdominal adhesion: an experimental study in a rat model

BACKGROUND This study was performed to determine the effect of alpha lipoic acid, a powerful antioxidant, on intra-abdominal adhesion formation. METHODS Twenty-four female Wistar Albino rats weighing 250-300 g were used in this study conducted on three groups consisting of the alpha lipoic acid group (Group I, n=8), control group (Group II, n=8), and sham group (Group III, n=8). After performing laparotomy with a midline incision under general anesthesia, the adhesion model was created on the antimesenteric side of the caecum in Group I and Group II. 50 mg/kg alpha-lipoic acid was administered intraperitoneally (IP) in Group I while the surgical procedure was performed but no drugs administered in Group II. Only laparotomy was performed in Group III. Rats were sacrificed at the end of the tenth day. RESULTS Macroscopic scoring was performed, tissue samples were obtained and subjected to biochemical and histopathological evaluation. The degree of adhesion and malondialdehyde level decreased (p<0.01), and glutathione levels had increased (p<0.01) in Group I compared to Group II in macroscopic scoring. CONCLUSION Alpha lipoic acid was found to significantly decrease (p<0.01) intra-abdominal adhesion when administered IP compared to the control group.

Combination of Cholecystectomy and Salpingooophorectomy in Keyless Abdominal Rope-lifting Surgical Technique

Introduction: During keyless abdominal rope-lifting surgery (KARS) the intra-abdominal operations are performed through the single intra-umbilical incision following the lifting of the abdominal wall by sutures loaded in the Veress cannula without using CO2 and trocars. However, it is unclear whether KARS is suitable for the combination of two different surgical procedures performed in the lower and upper abdominal viscera. In this paper we aimed to present the first case of the combination of cholecystectomy and salpingooophorectomy performed by using the KARS technique. Case Report: A sixty-seven year old, gravidity 7, parity 7, postmenopausal woman was referred to our center with the symptoms of nausea, vomiting and right upper abdominal pain. Physical examination was not remarkable other than a mild right upper abdominal tenderness and a positive Murphy sign. Ultrasound examination revealed a hydropic gall bladder with micro calculi and the bile duct was dilated with a width of 11–12 mm and there was an image compiled with bile sludge located distal to the dilatation area. In addition, there was a septated cyst with 95x65x46 mm diameters in the left adnexal region. Cholecystectomy and salpingoophorectomy were performed through the same single incision of KARS. The woman was discharged at the 2 postoperative day. Conclusion: To our knowledge, this is the first case report presenting the operative management of a gall-bladder disease and adnexal cyst by using a single incision and gasless minimal invasive surgical technique. KARS seems feasible for the combination of cholecystectomy and salpingoophorectomy.

Effects of dextran-40 on flap viability after modified radical mastectomy

BACKGROUND Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40. OBJECTIVE To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy. METHODS Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed. RESULTS Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement. CONCLUSIONS Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.

Gastrik poliplerde endoskopik tanı ve yönetim: Bir klinik çalışma

HASTALAR VE YONTEM Bu calisma Agustos 2008 ile Aralik 2011 tarihleri arasinda Kafkas Universitesi Tip Fakultesi Genel Cerrahi Anabilim Dali endoskopi unitesinde, ust endoskopi yapilan hastalarda gerceklestirildi. Butun hastalara sedasyon amacli faringeal topikal anestezik madde olan %10’luk lidokain ve intravenoz midazolam uygulandi. Saptanan poliplerden uygun olanlar endoskopik polipektomi yontemiyle cikarildi. Polipektomiye uygun ARAŞTIRMA YAZISI