Cengiz Aydin

Efficacy of Chlorhexidine Gluconate During Surgery for Hydatid Cyst

BackgroundDissemination of protoscolices-rich fluid during surgery for hydatid cyst disease is a major cause of recurrence. Instillation of a scolicidal agent into a hepatic hydatid cyst before opening is the most commonly employed measure to prevent this serious complication. In this clinical study, the efficacy of 0.04% chlorhexidine gluconate (Chx-Glu) during hydatid cyst surgery was tested, and early-term results were evaluated.MethodsA total of 30 consecutive patients with 45 liver cysts were studied. Only type I and type II cysts were included. Cysts were punctured, and fluid was aspirated. The viability of protoscolices in this fluid was determined. Chx-Glu 0.04% was instilled into the cyst cavity. After 5 minutes of exposure, the cyst fluid was reaspirated and evaluated for the viability of protoscolices. Imprints of the germinative membranes were determined for protoscolices viability.ResultsAll protoscolices in 45 cysts evaluated were killed by 5 minutes of exposure to 0.04% Chx-Glu. The whole of the germinative membrane imprints contained dead protoscolices. Chx-Glu 0.04% did not cause any adverse effect on biliary tracts in communication with cysts. There was no recurrence during the 2-year follow-up period. There were also no mortality and no cavity-related complications.ConclusionsThis study shows that intracystic injection of 0.04% Chx-Glu is an effective measure against the dissemination of viable protoscolices. In addition, Chx-Glu is the most convenient scolicidal agent as per the criteria defined by the World Health Organization. Therefore, it can be used safely during hydatid cyst surgery. However, there remains the need to perform advanced comparative clinical studies on the efficacy of Chx-Glu and other scolicidal agents.

Pancreatic Pseudotumor due to Peripancreatic Tuberculous Lymphadenitis

Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-level obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the operation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient recovered well. An abdominal tuberculoma is often mistaken for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge.

Sigmoid colon perforation as an unusual complication of Behçet's syndrome: report of a case.

Abstract.A 47-year-old man with long-standing Behçets syndrome presented with an acute abdomen, and was found to have perforation of the sigmoid colon. Laparotomy revealed gangrenous changes in the sigmoid colon and perforation in the center of the affected segment. This is a very rare complication of Behçets disease, and we report this case to stress the importance of performing careful abdominal examination while evaluating patients with Behçets disease.

Thyroid Hormone Supplementation in Sepsis : An Experimental Study

Abstract.Purpose: The levels of thyroid hormones decrease in septic, critically ill, and major trauma patients who show a bad prognosis. The aim of this study was to investigate the effects of thyroid hormone supplementation on the sepsis criteria and mortality in an experimental sepsis model. Methods: Forty-eight Wistar-Albino rats were divided into four experimental groups. A cecum ligation and puncture was used as a sepsis model. Group I: sham; group II: a cecum ligation and puncture (control); group III: a cecum ligation and puncture +T3 (0.4 μg/100 g body weight/day) intraperitoneally; group IV: a cecum ligation and puncture +T4 (1 500 ng/100 g body weight/day) intramuscularly. The PCO2, leukocyte count, peritoneal bacterial content, neutropenia, and mortality rates were assessed in all groups. Results: The PCO2 levels decreased only in the control group (P < 0.05). The leukocyte counts were lower in the therapy groups (P < 0.05). The rate of neutropenia was seen much more in the control group (P < 0.05). The peritoneal bacteria content decreased in the therapy groups (P < 0.05). The mortality rate significantly decreased in the thyroid hormone-treated animals (P < 0.05). Conclusions: Thyroid hormone supplementation in septic rats had a beneficial effect on the sepsis criteria and also resulted in a lower rate of mortality.

The Effects of Various Scolicidal Agents on the Hepatopancreatic Biliary System

Sclerosing cholangitis is a rare but dreadful complication of liver hydatid surgery. Almost all scolicidal agents were shown to be potentially associated with this complication clinically or experimentally. This experimental study was designed to examine the effects of 0.04% chlorhexidine gluconate and 95% ethanol on the hepatobiliary system and pancreas and also to compare their effects with 10% povidone iodine and hypertonic 20% saline. Materials and Methods: 50 Wistar rats were divided into equal five groups identified as: 0.9% NaCl (control group), 0.04% chlorhexidine gluconate, hypertonic 20% saline, 10% povidone iodine, and 95% ethanol. Scolicidal agents were injected into the biliary tract through a duodenal puncture. The animals were kept for 3 months. The animals were sacrificed, and histopathological examinations of the liver, biliary tract, and pancreas were performed. Results: The most severe histopathological changes of the liver, biliary tract, and pancreas were found in the ethanol group, and the least changes were detected in the chlorhexidine gluconate group. Conclusion: This experimental study confirms the deleterious effect of 95% ethanol on hepatopancreatic biliary system when used for the percutaneous drainage of hydatid diseases. For treatment of hydatid cysts in the hepatobiliary system, 0.04% chlorhexidine gluconate should be used as scolicidal agent.

Relaxant effect of omeprazole and lansoprazole in guinea pig gallbladder muscle strips in vitro

Background. The aim of this study was to investigate the role of omeprazole and lansoprazole, H+-K+ ATPase inhibitors, in gallbladder smooth muscle contractility in vitro. Methods. Gallbladder muscle strips obtained from guinea pigs were mounted in an organ bath. The responses of both precontracted strips and strips under basal tension to omeprazole and lansoprazole were determined. Results. Spontaneous contractile activity was blocked following omeprazole and lansoprazole administration. The agents also caused concentration-dependent relaxation in carbachol- and KCl-precontracted gallbladder muscle strips. Pretreatment with atropine (1 µM), NW-nitro l-arginine methyl ester (l-NAME; 30 µM), indomethacin (10 µM), ammonium chloride (7.5 mM), sodium acetate (7.5 mM), tetraethylammonium chloride (0.5 mM), glibenclamide (1 µM), 4-aminopyridine (0.1 mM), or clotrimazole did not inhibit this relaxation. Gallbladder strips were placed in high-concentrtion potassium (80 mM), calcium-free solution. The contraction produced with the addition of Ca2+ (2.5 mM) was completely relaxed by omeprazole, lansoprazole, and nifedipine separately. Conclusions. These results demonstrate that omeprazole and lansoprazole have potent inhibitory effects on spontaneous contractions and cause dose-dependent relaxation in precontracted gallbladder smooth muscle strips of guinea pig in vitro. This effect could be due to blockade of the calcium channels.

Could total thyroidectomy become the standard treatment for Graves’ disease?

PurposeGraves’ disease is the most frequent cause of hyperthyroidism. Although treatment with antithyroid drugs or radioactive iodine is effective, surgery remains the preferred treatment for many patients. We analyzed the results of 55 prospectively followed patients who underwent total thyroidectomy for Graves’ disease.MethodsTotal thyroidectomy was performed by experienced endocrine surgeons in all 55 patients. We monitored the patients postoperatively for early and late complications.ResultsThere were 19 men, with a mean age of 42 years (range, 34–68 years) and 36 women, with a mean age of 38 years (range, 19–78 years). One patient suffered postoperative hemorrhage and subsequent wound infection, two patients had transient recurrent laryngeal nerve palsy, and 24 patients had transient hypocalcemia. The mean follow-up time was 4 years (range, 10 months to 6 years). Recurrence of hyperthyroidism was not reported in this period.ConclusionRemoval of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism. Total thyroidectomy is the most effective surgery for achieving the goal of treatment of Graves’ disease to ensure that hyperthyroidism will not recur.

The impact of Ramadan on peptic ulcer perforation

BACKGROUND Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism.

Abstract. Dyspeptic symptoms are common in patients with primary hyperparathyroidism (PHPT) and have been attributed to hypercalcemia; however, they may also become permanent after parathyroid surgery. We aimed to evaluate the prevalence of Helicobacter pylori in patients with PHPT and to see whether there is a relationship between dyspeptic complaints and H. pylori infection. Of 21 patients with PHPT, 18 patients had dyspeptic complaints. These 18 female patients with PHPT and dyspeptic symptoms were the study population, and 20 female volunteers with dyspeptic symptoms were the controls. An endoscopic examination was performed in all controls and in patients before parathyroid surgery. H. pylori was assessed by serological and histological evaluation. H. pylori was identified upon histological evaluation in 17 patients (94.4%) and serologically in 17 patients (94.4%). Active macroscopic and microscopic gastritis were found in 15 (83.3%) and in 17 (94.4%) of the patients, respectively. In the control group, H. pylori was identified histologically in 13 subjects (65%) and serologically in 17 subjects (85%). The prevalence of H. pylori assessed by histological examination was significantly (P < 0.05) different between patients and controls. There was a significant association between H. pylori infection identified by histology and/or serology and the presence of microscopic (r = 1; P < 0.001), as well as macroscopic (r = 0.54; P < 0.05), gastritis. In conclusion, this study showed that H. pylori infection was found frequently (85.7%) in patients with PHPT. In the management of PHPT with or without surgery, patients, especially those with dyspeptic symptoms, should be evaluated for H. pylori infection, which can be effectively eradicated by appropriate therapy.

Enhancement of EFS-induced contractions, by agmatine, in guinea pig gallbladder smooth muscle strips.

BackgroundElectrical field stimulation of gallbladder muscle strips produces frequency-dependent contractions by activating cholinergic nerves. The cholinergic motor function of the gallbladder and enteric system is also modulated by other mediators. The aim of this study was to investigate the role of agmatine, a ligand for alpha 2-adrenoceptors and imidazoline binding sites, in the cholinergic motor activity of guinea pig gallbladder smooth muscle.MethodsGallbladder muscle strips obtained from guinea pigs were subjected to electrical field stimulation (1–64 Hz, 100 V, 1-ms pulse width, and 10-s train duration). Frequency-response contractions of gallbladder muscle strips were traced before and after the addition of cumulative concentrations of agmatine (10−5–10−3 M) to the tissue bath. The same set of experiments was repeated in the presence of different antagonists.ResultsAgmatine by itself did not produce any contractions in guinea pig gallbladder muscle strips, but significantly enhanced the contractile response produced by electrical field stimulation. Yohimbine (10−6 M), a selective alpha 2-adrenergic blocker, neither decreased nor increased the enhancement induced by agmatine. However, idazoxan (10−4 M), an alpha-receptor blocker and imidazoline receptor antagonist, abolished this enhanced contractile response. Pretreatment with NW-nitro l-arginine methyl ester (l-NAME; 30 µM), and indomethacin (10 µM) did not inhibit the effect of agmatine.ConclusionsOur findings indicate that agmatine has a modulator role in the electrical field stimulation-induced cholinergic contractions of guinea pig gallbladder smooth muscle strips, and this role could be mediated by imidazoline receptors. Receptor binding studies should be done to determine the presence of endogenous agmatine and imidazoline receptors in gallbladder smooth muscle.