Burhan Mayir

Protective effects of amifostine on ischemia-reperfusion injury of rat kidneys

Objectives: Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent exposure. It is used to decrease the renal toxicity of cisplatin. The aim of this study was to determine the role of amifostine in warm ischemia kidney model for prevention of ischemia/reperfusion injury and also to find out the mechanism for prevention from ischemia/reperfusion injury if such an effect does exist. Materials and Methods: Adult female rats (n = 40) that used in our study were divided into three groups. Group 1: Control (n = 8), group 2: Ischemia-control (n = 16), group 3: Amifostine treated (n = 16). The effect of amifostine on ischemia/reperfusion injury investigated in rat kidneys. Results: At the 7th day, blood urea nitrogen level was statistically significantly higher in ischemia-control group than all groups (P = 0.001) and mean serum creatinine levels were found to be the highest in ischemia-control group (P = 0.091). Mean malondialdehyde levels in left kidneys removed on the 7th day were not significantly different (P = 0.105) at all three groups. Between ischemia-control group and amifostine group, there was a significant difference in reduced glutathione (GSH) levels (P = 0.001). In amifostine group, grade 4 necrosis was not detected neither on 7th day nor day 0. Conclusion: Amifostine could decrease the degree and severity of necrosis after reperfusion. Amifostine could not prevent membrane lipid peroxidation caused by superoxide anion radicals in kidney but they could protect tissues from the harmful effects of ischemia/reperfusion injury by increasing the level of reduced GSH which is a well-known oxygen radical eliminator.

Methods for closure of appendix stump during laparoscopic appendectomy procedure

The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others.

Genel cerrahi alanında Türkiye'den yayınlanan ve en çok atıf alan makaleler

OBJECTIVE The citation number of an article gives us information about its quality and contribution to science. In this article, we aimed to find the most frequently cited article in general surgery from Turkey, and evaluate how these articles in general surgery contributed to the world literature. MATERIAL AND METHODS We used the science citation index expanded database to find the most frequently cited articles in general surgery from Turkey. RESULTS Among the 52 articles found, the most common subjects were as follows: hydatid cyst (21.1%), pilonidal disease (15.4%), laparoscopic operations (15.4%), breast diseases (11.5%), and inguinal hernia (7.7%). Two articles were cited in more than 100 articles. Furthermore, 48.8% of the articles were published from three major cities. Most articles were published between 2000 and 2004, and 65.4% of articles were case series. CONCLUSION Most of the cited articles were about hydatid cyst and pilonidal disease, which are more common in the Turkish population compared with other countries. Evaluation of most cited articles is important to identify the fields in which Turkey contributes to the world literature.OBJECTIVE: The citation number of an article gives us information about its quality and contribution to science. In this article, we aimed to find the most frequently cited article in general surgery from Turkey, and evaluate how these articles in general surgery contributed to the world literature. MATERIAL AND METHODS: We used the science citation index expanded database to find the most frequently cited articles in general surgery from Turkey. RESULTS: Among the 52 articles found, the most common subjects were as follows: hydatid cyst (21.1%), pilonidal disease (15.4%), laparoscopic operations (15.4%), breast diseases (11.5%), and inguinal hernia (7.7%). Two articles were cited in more than 100 articles. Furthermore, 48.8% of the articles were published from three major cities. Most articles were published between 2000 and 2004, and 65.4% of articles were case series. CONCLUSION: Most of the cited articles were about hydatid cyst and pilonidal disease, which are more common in the Turkish population compared with other countries. Evaluation of most cited articles is important to identify the fields in which Turkey contributes to the world literature.

Rectal leiomyosarcoma, late complication of pelvic radiotherapy

Rectalleiomyosarcoma(LMS)isararediseaseoccupyinglessthan 0.1 % of colorectal tumors [1]. Even if we know therelation between radiation and colorectal carcinomas, the re-lation between radiation and LMS is not certain because ofuncommon existence. Up to date, rectal LMS after pelvicradiotherapy was detected in four patients. Our case is thefifth patient in literature.A75-year-oldfemalepatientwasadmittedtoourclinicwithacomplaint of change in bowel habits. In history, she has aunilateral oophorectomy with diagnosis of ovarian maligncystic lesion 35 years ago, and afterwards, she has undergoneradiotherapy of 15 days duration. Her physical examinationwas normal. In laboratory assessments, anemia and occultblood in her stool were detected. Her CA-125 level waselevated; other tumor marker (CEA, CA19-9, AFP, CA15-3)levelswereallnormal.Therewerenotanypathologicfindingsin transabdominal ultrasound examination, but a mass lesionin the rectum with a diameter of 7 cm was detected withabdominal computerized tomography. During endoscopy, at9 to 10 cm proximal to the anus, a tumoral lesion obliteratingintestinal lumen was seen and biopsy was taken. The histo-pathologicalexaminationofthebiopsyspecimenrevealedthatit is a LMS. Tumor cells stained positively for vimentin andactin but negatively for PanCK. Metastasis examination wasdone and no metastasis was detected.After informing the patient and completing preoperativepreparations, low anterior resection was performed. Therewere not any complications in the postoperative period.Patient was discharged at the sixth day of operation. In histo-pathologicalexamination,thetumorsizewasreported8cmindiameter. Fourteen lymph nodes were removed at the opera-tionandmetastasiswasnotdetected.Tumorcellswerestainedpositively for vimentin, but negatively for pancytokeratin,S100,beta-catenin,CD3,CD117,anddesmin.Fifteenmitoseswere recognized at ten times magnification.Ten percent of smooth muscle tumors are LMS.Leiomyosarcoma of the gastrointestinal tract is generally lo-cated at the stomach or small bowel, rarely at the colon orrectalregion.Itoriginatesfromthemuscularmucosaorproprialayer of the gastrointestinal tract. Whereas radiotherapy is awell-known risk factor for colon carcinoma, for colorectalLMS, its role is not well defined. Because of small numberof patients, it is difficult to show the correlation in between.Sarcomas after radiotherapy account for 0.5–5.5 % of allsarcomas. Most of them are osteosarcoma and fibrosarcoma.Differentiation of sarcoma as primary tumor or secondary toradiotherapy is important for clinical and academical ap-proaches. But there is not any strict criterion for differentia-tion. Cahan introduced some criteria for this reason whichwere revised by Huvos afterwards [2]. With regard to theserevised criteria, if patient has history of radiotherapy, if diag-nosed sarcoma is at the same region of radiotherapy, if sarco-ma is diagnosed long after radiotherapy, and if sarcoma isdiagnosedhistologically,onecansaythatsarcomaisrelatedtoradiotherapy. Paulino et al. investigated secondary cancerdevelopment after exposure to radiotherapy due to malignantdiseases. They reported malignant tumor development afterradiotherapyat5.4%ofpatients,andat71%ofthesepatients,tumor development is at the same side of radiotherapy.Secondary sarcomas were detected 4.6–33.6 years (averageof 10.1) after the first tumor [3]. In another study, secondarycancer development period after exposure to radiotherapy atadult agehood is found to be 5–40 years interval.

Bariatric Surgery and Fertility

Reproductive concerns and pregnancy outcomes after bariatric surgery is performed are important issues for patients, general surgeons, and obstetrics and gynecology specialists. Although there are no official guidelines available concerning the pregnancy outcome after bariatric surgery is performed, being pregnant after bariatric surgery is performed seems to be safe. However, conception is not recommended within the first year of undergoing bariatric surgery when there is rapid weight loss. Patients must be carefully evaluated before conception, and necessary supplements such as vitamins and folic acid must be recommended.

Effects of different intraabdominal pressure levels on oxidative stress markers in laparoscopic cholecystectomy

OBJECTIVE To evaluate the effect of laparoscopic cholecystectomy performed under different intraabdominal pressure on oxidative stress markers. MATERIAL AND METHODS This prospective, randomized, controlled study examined 90 consecutive healthy patients who underwent elective laparoscopic cholecystectomy with the diagnosis of symptomatic cholelithiasis. The patients were divided into three groups, 30 patients in each. Group 1 included patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 7 mmHg, Group 2 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 10 mmHg, and Group 3 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 13 mmHg. Blood samples were collected preoperatively, perioperatively, and postoperatively for measurement of the serum levels of ischemia modified albumin and an analysis of total antioxidant status and total oxidant status. Intra-group comparisons were made. RESULTS Group 1 experienced a significant increase in the postoperative ischemia modified albumin values compared to preoperative ischemia modified albumin values (p=0.013). Group 2 experienced a significant decrease in the perioperative total antioxidant status values compared to preoperative and postoperative total antioxidant status values (p=0.009). Group 3 experienced a significant increase in the perioperative total oxidant status and oxidative stress index values compared to preoperative values (p<0.001). Group 3 experienced a significant increase in the perioperative and postoperative ischemia modified albumin values compared to preoperative values (p<0.001). CONCLUSION Increased levels of oxidative stress markers were detected in patients who underwent laparoscopic cholecystectomy at a high intraabdominal pressure level.

Analysis of the publishing rate and the number of citations of general surgery dissertations

OBJECTIVE A dissertation is a scientific document. However, if it is not published in a scientific journal, it will gain access to only a limited audience and thus will be unable to achieve its objective. Nevertheless, the rate of publishing in journals is not high among dissertations. In this study, we aimed to investigate the publishing rates of general surgery dissertations in journals and the total number of citations. MATERIAL AND METHODS All medical dissertations that have been prepared at general surgery departments of university hospitals and presented between the years 2006 and 2008 were analyzed. The authors checked whether the dissertations were published in a journal or not, by searching the dissertation in 4 different resources with the name of their authors. RESULTS Two hundred and thirty-two dissertations were included. Half of those dissertations were experimental animal studies. Seventy dissertations were published in various journals. Fifty one (22%) of these were published in Science Citation Index Expanded journals, while 19 (8.1%) of them were published in Turkish non-Science Citation Index Expanded journals. There was no significant difference in terms of publishing rates between study types. The number of annual citations per article was 1.1. The writer of the dissertation was the first author in 35 (68,6%) articles. CONCLUSION The publishing rates of dissertations in general surgery is low, with only 22% being published in Science Citation Index Expanded journals. The citation rate was also detected to be low in our study. Consequently, a dissertation should be considered as a scientific research study and planned as such, not as obligatory assignments. The publishing rates of dissertations should be increased, and authors should be led and encouraged to publish their dissertations.

Why scientists perform animal experiments, scientific or personal aim?

OBJECTIVE Although all animal studies are conducted in line with a specific purpose, we think that not all animal studies are performed for a scientific purpose but for personal curiosity or to fulfill a requirement. The aim of the present study is to reveal the purposes of experimental studies conducted on animals. MATHERIAL AND METHODS We searched for experimental studies performed on rats in general surgery clinics via PubMed, and obtained the e-mail addresses of the corresponding authors for each study. Afterwards, we sent a 7-item questionnaire to the authors and awaited their responses. RESULTS Seventy-three (22.2%) of 329 authors responded to the questionnaire. Within these studies, 31 (42.5%) were conducted as part of a dissertation, while the remaining 19 (26.0%) were conducted to meet the academic promotion criteria. Only 23 (31.5%) were conducted for scientific purposes. The cost of 41% of those studies was higher than 2500

The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients

. CONCLUSION As shown in this study, the main objective of carrying out animal studies in Turkey is usually to prepare a dissertation or to be entitled to academic promotion. Animal experiments must be planned and performed as scientific studies to support related clinical studies. Additionally, animal studies must have well-defined objectives and be carried out in line with scientific purposes that may lead to useful developments in medicine, rather than personal interests.