Bülent Kaya

Acute Appendicitis during Pregnancy

Background: To analyze the diagnosis and surgical treatment of acute appendicitis during pregnancy. Methods: The records of 24 pregnant patients who underwent surgery with preliminary diagnosis of acute appendicitis between January 1990 and July 2000 were reviewed retrospectively. Results: Between January 1990 and July 2000, there were 31,480 deliveries and the incidence of acute appendicitis was 1/1,312. Twenty patients had pathologically proven acute appendicitis (83.3%). Of the remaining 4 patients, one had hemorrhagic ovarian cyst, one had ovarian cyst rupture and in two cases no surgical pathology was diagnosed. Gestational stage at the diagnosis was first trimester in 7 patients, second trimester in 12 patients and third trimester in 5 patients. Five patients had abortions and premature delivery occurred in 2 patients. Conclusion: Diagnosis of acute appendicitis is difficult in pregnancy. Delay in diagnosis and surgery results in increase in complications. Emergency surgical intervention should be performed when acute appendicitis is suspected during pregnancy.

Paraoxonase and arylesterase activities, lipid profile, and oxidative damage in experimental ischemic colitis model.

Objective. In the present study, since PON1 is known as an HDL-associated antioxidant enzyme that inhibits the oxidative modification of LDL and oxidative stress plays a role in the pathogenesis of mesenteric ischemia, we investigated the changes in PON1 activity and lipid profile in an experimental ischemic colitis model. Methods. Forty male Wistar albino rats were divided into two groups: the control group (N = 15) and the experimental group (N = 25). All animals were anesthetized with ether and ketamine anesthesia to undergo a midline laparotomy. Ischemic colitis was induced by marginal vessel ligation in the splenic flexura (devascularization process). A sham laparotomy was performed in the control group. All animals were sacrificed on the seventh postoperative day. Oxidative stress marker (malonyldialdehyde, MDA), lipid profile, and paraoxonase (PON-1) and arylesterase activities were determined. Histopathological evaluation was done under light microscopy, after sectioning and staining with hematoxyline and eosin. Statistical analysis was conducted using Students t-test and Mann-Whitney U test, and P < 0.05 was considered as statistically significant. Results. There was a significant decrease in both serum and tissue PON1 activity in ischemic colitis group (P < 0.01, for each). Similarly, arylesterase levels showed a parallel decrease in both tissue and serum of the experimental group (P < 0.01 and P < 0.001, retrospectively). MDA, an oxidative stress marker, was seen to increase in the experimental group (P < 0.01, tissue; P < 0.05, serum). In experimental group, there was a significant rise in serum total cholesterol and LDL levels (P < 0.001, for each). However, HDL level decreased significantly (P < 0.001). Triglycerides did not show any change between the groups (P > 0.05). Conclusions. PON1 and arylesterase play an important role in the pathophysiology of ischemic colitis.

Splenic hydatid cyst attacking retroperitoneum.

Hydatid disease most commonly affects the liver and lungs but no organ is immune. Splenic hydatid cyst is a rare clinical entity. Although the patients are usually asymptomatic, the disease may present with secondary infection, adhesion to adjacent organs with fistulisation or rupture into abdominal cavity. We present a 67 year old women with splenic hydatid cyst. Severe adhesions and tumorlike growth were found in the retroperitoneal region. To our knowledge, retroperitoneal invasion with a splenic hydatid cyst is a very rare clinical condition. Total splenectomy was performed without complication.

Diagnostic Role of Colon Capsule Endoscopy in Patients with Optimal Colon Cleaning

Background. Colon capsule endoscopy (CCE) is a diagnostic test with relatively rare usage. In this study, we aimed to evaluate both the optimal cleaning regimen for CCE and the diagnostic value of test in the study group. Methods. A total of 62 patients were enrolled in this study. In the first step, 3 different colon preparing regimens were given to 30 patients [Group A: 3 days of liquid diet, sodium phosphate (NaP) (90 mL), and NaP enema; Group B: 3 days of liquid diet, 4 L of polyethylene glycol (PEG), and metoclopramide; Group C: 3 days of liquid diet, 4 L of PEG, NaP (45 mL), and bisacodyl after capsule ingestion] (10 patients in each group). The other consecutive 32 patients were cleaned with the best regimen which was NaP + PEG and CCE was performed. The results of CCE were controlled with colonoscopy in 28 patients. Results. Group C had the highest cleaning score, compared with the other groups (2.2 ± 0.4 versus 2.7 ± 0.4 versus 3.7 ± 0.4, p value = 0.000). The CCE findings were as follows in 28 patients who were also examined with colonoscopy: polyp (range: 5–10 mm) in 6 patients, internal hemorrhoids in 3 patients, angiodysplasia in 1 patient, diverticula in 1 patient, and ulcerative colitis in 1 patient. The sensitivity, specificity, PPV, and NPV of CCE were 100%, 92%, 93%, and 100%, respectively. Conclusions. Low dosage NaP combined with PEG provides optimal bowel preparation for CCE. CCE appears to be a highly sensitive diagnostic modality for detecting colonic pathologies.

Mekanik barsak tıkanıklığı tanısı ile opere edilen 68 olgunun etyolojik ve klinik bulguları: Tek merkezli retrospektif analiz

GIRIŞ Mekanik barsak tikanikligi (MBT) ilk kez Praxogaras tarafindan barsak-cilt fistulu olusturularak tedavi edilmeye calisilmistir. Tum dunyada cografi farkliliklarla MBT etiyolojisi de farkliliklar gostermektedir (1). Son yillarda ozellikle Bati ulkelerinde adezyonlara bagli MBT oranlarinda artis meydana gelmistir (2-5). Ulkemizde de adezyonlar onemli bir etyolojik sebep olmakla beraber fitiklar en sik gorulen patolojilerdir (6,7). Tani ve tedavi yontemlerindeki gelismelere ragmen, halen MBT bulgulari ile opere edilen hastalarda yuksek morbidite ve mortalite oranlari ile karsilasilmaktadir.

Delay in Diagnosis of Intestinal Obstruction in a Patient with Familial Mediterranean Fever

Familial Mediterranean Fever (FMF) is a recurrent disease characterized by inflammatory process effecting synovial membranes such as peritoneum, pericardium and joints. It usually presents with acute abdominal pain. Intestinal obstruction secondary to adhesions may be observed in FMF patients. Sometimes diagnosing intestinal obstruction can be a challenging problem. We were presented a patient with FMF and adhesive intestinal obstruction. He was operated on after 10 days of symptoms. Delay in diagnosis and treatment of the case discussed with literature review.

Primer apendajitis epiploika: Konservatif tedavi edilen iki olgu

GİRİŞ Apendiks epiploika (AE), kolon duvarında seroza ile kaplı, pediküllü, yağ dokusunca zengin oluşumlardır. Sıklıkla transvers ve sigmoid kolonda yerleşirken, tüm kolonda 50 ile 100 adet arasında AE bulunur. Arteryel beslenmelerinin zayıflığı ve serbest hareket edebildikleri pediküllü yapıları nedeni ile torsiyon ve infarkt ile kolaylıkla karşılaşabilirler (1,2). Kolon peristaltizmine yardım ve büyük omentum benzeri mekanik koruma görevleri olduğu ifade edilmiştir.