Cenap Dener

Breast abscesses in lactating women.

We designed a prospective study to assess the contributing factors in puerperal breast abscess and to evaluate the treatment options. During the 4-year study period, 128 nursing women with breast infection were followed. Of these, 102 had mastitis (80%) and 26 had breast abscess (20%). Ultrasonographic examination was performed in all cases. Patient age, parity, localization of infection, cracked nipples, duration of lactation, duration of symptoms, milk culture results, breast infections during previous lactation period, treatment options, healing time, and recurrence were recorded prospectively. All mastitis patients were treated with antibiotics and none developed an abscess. Ten abscesses were aspirated, and 16 abscesses were treated by incision and drainage. Healing times were similar. There was no significant difference between mastitis and abscess groups regarding age, parity, localization of breast infection, cracked nipples, positive milk cultures, or mean lactation time. Duration of symptoms and healing were longer in cases of abscess. Multivariate analyses showed that duration of symptoms was the only independent variable for abscess development. Recurrent mastitis developed in 13 patients (10.2%) within a median of 24 weeks of follow-up. Delayed treatment of mastitis can lead to abscess formation, and it can be prevented by early antibiotic therapy. Ultrasonography is helpful for detecting abscess formation. In selected cases the abscess can be drained with needle aspiration with excellent cosmesis.

Local anesthesia use for laparoscopic cholecystectomy

This study aimed to investigate the effects and timing of local anesthesia during laparoscopic surgery in terms of postoperative pain, nausea, and the need for opioids and antiemetics. This prospective study was carried out on 142 patients who underwent laparoscopic cholecystectomy. Peroperative local anesthesia was not administered to 53 patients (group A). The skin, subcutis, fascia, and parietal peritoneum were infiltrated with 0.5% bupivacaine HCl at trocar sites before trocar insertion in 46 patients (group B). Local anesthesia was given to 43 patients in equal doses at the same sites and the same manner at the end of surgery (group C). The higher requirement for analgesics in group A patients was statistically significant when compared with that in group B and C patients. The mean doses of analgesics postoperatively were significantly higher in group B than in group C. The time delay to the first antiemetics was significantly shorter in group A than in group C. Applying local anesthesia to the skin, subcutis, fascia, and parietal peritoneum through trocar sites reduces the postoperative analgesic requirement and pain intensity. This approach is more effective when applied at the end of an operation than at the start.

Urinary retention after elective cholecystectomy.

BACKGROUND There are few reports about urinary retention rate after elective cholecystectomy. We designed a prospective study to assess the problem. METHODS A total of 121 female and 19 male patients were included in the study with a prospective study protocol. Laparoscopic cholecystectomy was performed in 107 patients and open cholecystectomy in 33 patients. RESULTS Neither gender nor age affected rate. Postoperative micturition difficulty developed in 10 patients. Of these patients, 9 could void with helping measures, and only 1 needed catheterization. Only 1 patient who underwent laparoscopic surgery required catheterization (0.7%). The open approach caused a higher incidence of postoperative micturition difficulty than did the laparoscopic approach (15.2% versus 4.7%; P = 0.04). Only large amounts of perioperative fluid administration and meperidine use had statistically significant effects on micturition problems. CONCLUSIONS Urinary retention is a rare complication after elective cholecystectomy. Helping measures are very effective and should be tried before inserting a urethral catheter.

The Effect of Purified Micronized Flavonoid Fraction on the Healing of Anastomoses in the Colon in Rats

PurposeAnastomotic leakage of colonic and rectal anastomoses is a major complication after large intestine surgery. Many factors influence the healing of colon anastomoses. Flavonoids have been recognized for centuries as physiologically active constituents that are used to treat human diseases. We studied the effects of a clinically used, micronized, purified flavonoid fraction on the healing of colonic anastomosis in rats.MethodsMale Sprague–Dawley rats were used. The flavonoid group of rats received 100 mg/kg per day of Daflon for 14 days until surgery. Thereafter, a resection and anastomosis were performed. The bursting pressure of the anastomoses and the hydroxyproline levels of the perianastomotic tissue were determined to evaluate the healing on the third and seventh days of surgery for both flavonoid and control groups.ResultsThe bursting pressure of the flavonoid group was higher on the seventh day. The hydroxyproline levels of the flavonoid group were significantly higher than in the control group on both the third and seventh days after surgery.ConclusionsAlthough the micronized purified flavonoid fraction has some inhibitory properties on the healing of the anastomosis, its net effect was to obtain a better anastomotic healing of the colon in rats.

Comparison of Direct Trocar and Veress Needle Insertion in the Performance of Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract Veress needle insertion, direct trocar insertion and open technique are different methods of establishing pneumoperitoneum to perform a successful laparoscopic procedure. We conducted this study to compare the use of a Veress needle and direct trocar insertion to create pneumoperitoneum. 274 laparoscopic cholecystectomy operations were evaluated. There were no significant differences in the age and gender between Veress needle and direct trocar entry groups. In this study we have seen that the complication rate while performing pneumoperitoneum by direct trocar entrance was less than in Veress needle usage. Direct trocar entrance also reduces the operation time. In laparoscopic cholecystectomy the direct trocar entrance method is a more reliable and less time consuming method than Veress needle usage.

Effects of Aloe vera on colonic anastomoses of rats

Background:  Aloe vera is a cactus‐like plant that grows in hot, dry regions. Aloe vera has been known and used in traditional medicine and also in the modern world. Aloe vera has some pharmacological actions including wound healing, anti‐inflammatory and immunostimulatory effects. We have studied the possible effects of Aloe vera gel on the healing of colonic anastomoses of rats.

Recurrent Incisional Hernia due to Pseudomyxoma Peritonei

Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30 × 30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months.

Effect of Vitamin A on the CD44 Expression in the Small Intestine of Rats with Obstructive Jaundice

Hypothesis: In this study, the influence of obstructive jaundice on the CD44 expression in the rat small intestine and the alterations of this CD44 expression by vitamin A given intraperitoneally (200 IU/g/day) are evaluated. Materials and Methods: In a prospective animal model study, 32 Sprague-Dawley rats were randomized into four groups: group A rats (n = 8) underwent sham operation and were given daily saline intraperitoneally for 2 weeks (sham + saline); group B animals (n = 8) underwent sham operation and were given daily vitamin A intraperitoneally for 2 weeks (sham + vitamin A); group C rats (n = 8) underwent common bile duct ligation and were given daily saline intraperitoneally for 2 weeks (obstructive jaundice + saline), and group D animals (n = 8) underwent common bile duct ligation and were given daily vitamin A intraperitoneally for 2 weeks (obstructive jaundice + vitamin A). After 2 weeks, standardized jejunum and ileum segments were harvested from all animals. The expression of CD44 on the cell surface was evaluated immunohistochemically. Comparisons among the four groups were done. Results: The plasma bilirubin, aspartate transaminase, alanine transaminase, alkaline phospatase, and γ-glutamyltransferase levels in groups C and D (obstructive jaundice groups) were higher than those in groups A and B (sham groups; p < 0.05). There was no difference between groups A and B (sham groups) with regard to the number of cells expressing surface CD44 in jejunum and ileum. When groups A and B were compared with group C (obstructive jaundice + saline) animals, the number of cells expressing surface CD44 was significantly decreased in both jejunum and ileum in group C. The difference between sham groups (A and B) and group C was found to be significant (p < 0.05). When group D (obstructive jaundice + vitamin A) was compared with group C (obstructive jaundice + saline), the number of cells expressing surface CD44 was significantly increased in jejunum and ileum in group D animals (p < 0.05), higher than in the sham groups (A and B). The difference between group D and sham groups (A and B) was found to be significant (p < 0.05). Conclusion: Obstructive jaundice for 2 weeks significantly decreased the CD44 expression in the rat small intestine. We found that daily intraperitoneal administration of vitamin A in rats with obstructive jaundice for 2 weeks significantly restored the impaired CD44 expression.