Celalettin Keleş

Spontaneous Liver Hematoma and a Hepatic Rupture in HELLP Syndrome : Report of Two Cases

Subcapsular liver hematomas and ruptures are unusual fatal complications of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (HS). We present two cases of a spontaneous rupture of subcapsular liver hematoma occurring in HS and review the literature on this subjects. One case demonstrated a secondary rupture of a subcapsulary liver hematoma due to HS in one patient and HS associated with preeclampsia in another. The defects were on the medial and lateral sectors of the left lobe in one patient and on the medial sector of the right lobe in the other patient. In case 1 deep mattress sutures and omentoplasty were performed, and in the other case a defective area was closed with an absorbable gelatin sponge with a hemostatic effect. In addition, the liver was compressed by abdominal towels. A high index of suspicion and immediate recognition are keys to proper diagnosis and management of affected patients. The multidisciplinary approach to the management of these patients led to a remarkable decrease in the mortality rates. Less aggressive treatment is preferable to aggressive intervention such as a hepatic resection in such patients with coagulopathy.

Can mean platelet volume be a new risk factor in portal venous thrombosis

Background: The aim of this study was to discuss the possibility of mean platelet volume (MPV) being a new risk factor in the etiology of portal venous thrombosis (PVT). Methods: Study participants were categorized into 2 different groups: group I, control group (n = 35) and group II, PVT group (n = 34). Demographic data and MPV values were recorded retrospectively. Results: No differences were determined between the 2 groups regarding hypertension, diabetes mellitus, and smoking (P > .05). The average hemoglobin levels were 10.8 ± 2.1 in group II and 14.0 ± 1.7 in group I (P < .001). Although the MPV levels of group II patients were 8.2 ± 0.52, the average level in group I was determined as 7.8 ± 0.62 (P = .012). In the performed receiver–operating characteristic (ROC) analysis, the cutoff value for patients with PVT for MPV was determined as 7.9 (area under curve: 0.674), sensitivity as 70.6%, and specificity as 65.7% (P = .013). Conclusion: The current study shows that MPV is significantly higher in patients with PVT than in the control group.

Akut biliyer pankreatitli olgularda erken ve geç laparoskopik kolesistektominin yeri

GIRIŞ Akut pankreatit (AP) karin agrisi ile beraber kan ve idrarda pankreas enzimlerinin yuksekligi ile seyreden ve pankreasin cesitli derecelerde etkilendigi lokal doku ve organ sistemlerinin istirak ettigi inflamatuar bir olay olarak tanimlanir (1). Hastalik, hafif bir sekil olan odematoz pankreatitten agir bir klinikle kendini gosteren nekrotizan pankreatite kadar farkli siddette patolojik degisliklerle seyreder (2). AP’in yillik gorulme sikligi 5-80/100.000 olup, alkol ve safra taslari en sik etiyolojik nedenlerdir (3,4). Safra tasi pankreatiti tum pankreatit olgularinin yaklasik %40’ini olusturmaktadir. Bu nedenle akut biliyer pankreatitli (ABP) hastalarda akut atagin iyilesmesinden sonra kolesistektomi, olasi biliyer komplikasyonlari engellemek icin zorunludur. Fakat kolesistektominin zamanlamasi tartisma konusu olmaya devam etmektedir (5). Bu calismada ABP’li hastalarda erken ve gec laparoskopik kolesistektomi (LK) sonuclarini karsilastirarak, mortalite ve morbidite uzerine olan etkisini arastirmayi amacladik.

Erişkinlerde Görülen Meckel Divertikül Komplikasyonları

The aim of this study was to determine the effect of carbamazepine onserum lipid levels in epileptic patients who were on long-termcarbamazepine monotherapy. The study group were comprised of 30epileptic patients (10 female, 20 male) who have been on carbamazepinemonotherapy for at least one year whereas control group consisted of 30 ageand sex matched healthy controls. Serum cholesterol (total cholesterol,HDL cholesterol, LDL cholesterol) and triglyceride levels were measuredand LDL/HDL ratio was calculated in all subjects. Serum HDL cholesteroland triglyceride levels of study group were significantly higher than controlgroup whereas serum LDL cholesterol levels and LDL/HDL ratios of studygroup were lower than control group. Mean total cholesterol level of studygroup was lower than control group, however the difference did not reachstatistical significance level. Because of its effect on cholesterol levels, longterm carbamazepine could possibly have a positive influence in decreasingthe risk of developing aterosclerosis and coronary heart disease. Long termprospective follow-up studies would be helpful to us in enlightening this issuedefinitely.