Cengizhan Yigitler

Lower extremity venous changes in pneumoperitoneum during laparoscopic surgery.

Background:  The effect of pneumoperitoneum on veins of the lower limbs related to the intra‐abdominal working pressures during laparoscopic cholecystectomy has not been thoroughly investigated. We tested the hypothesis that working pressures do not affect the venous haemodynamics in the lower limbs.

Ischemia-Reperfusion Injury in the Liver During Renal Transplantation: Does Perfusion Solution Play Any Role?

The effect of ischemia-reperfusion (I/R) injury within a transplanted kidney has not been reported on the liver as a remote organ. One hypothesis is that there is no difference between kidney perfusion solutions regarding antioxidants in liver after an I/R injury. We used four pigs with Ringers lactate (RL); four with university of Wisconsin (UW); and two in a control (C) group. A liver parenchymal biopsy was obtained before renal artery/vein solution clamping for 20 minutes. Either RL or UW solutions were infused through arterial cannulas for 20 minutes as previously described elsewhere. For the sham group, we used 0.9% NaCl. After reperfusion for 20 minutes, we obtained a second liver parenchymal biopsy. Measurements of superoxide dismutase (SOD), glutathione peroxidase (GP-x), and malondialdehyde (MDA) levels were compared using paired student t tests within groups and analysis of variance between groups. The results were expressed as mean values +/- SEM with P < .05 accepted as significant. Although GP-x, SOD, and MDA decreased after ischemia-perfusion-reperfusion injuries in all groups, except MDA in UW and SOD, and MDA in C groups; only the MDA for C was significant (P = .04) Comparing the groups, GP-x (P = .01) and MDA (P = .003) levels after ischemia-perfusion-reperfusion were significant while changes in SOD levels did not show any difference (P > .05). In a kidney transplantation model, the liver was affected during the ischemia-perfusion-reperfusion process as evidenced by antioxidant enzymes. The pathophysiology and clinical importance of this phenomenon requires further study. Comparing the perfusion solutions, no difference was found between RL and UW regarding their effects to decrease renal I/R injury on the liver in pigs.

Adhesion-preventing properties of 4% icodextrin and canola oil: a comparative experimental study

OBJECTIVE: Postsurgical abdominal adhesions are common, serious postoperative complications. The present study compared the usefulness of 4% icodextrin and canola oil in preventing postoperative peritoneal adhesions. METHODS: Twenty-four Wistar albino rats were divided into three groups. Following a laparotomy, a serosal abrasion was made by brushing the cecum, and 3 mL of 0.9% NaCl, 4% icodextrin, or 3 mL of canola oil were intraperitoneally administered for the control, icodextrin, and canola oil groups, respectively. The abdomen was then closed. All of the rats were sacrificed at day 10. Macroscopic, histopathological, and biochemical evaluations were performed. The results were statistically analyzed using Kruskal–Wallis and ANOVA tests. RESULTS: Macroscopic analyses revealed that both canola oil and 4% icodextrin reduced adhesion formation, but the difference was not statistically significant (p = 0.17). The histopathological examinations revealed no significant differences in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM1, or PECAM1 scores. However, both canola oil and 4% icodextrin significantly reduced fibrosis (p = 0.025). In the canola oil group, the histiocytic reactions were significantly increased (p = 0.001), and the hydroxyproline levels were significantly lower than those in the other groups (p = 0.034). CONCLUSIONS: In the present study, canola oil was determined to be superior to 4% icodextrin in lowering hydroxyproline levels and increasing histiocytic reactions. Considering these results, we believe that canola oil is a promising agent for preventing adhesion formation.

Do we need to use subcutaneous suture for pilonidal sinus treated with excision and simple primary closure

Abstract Objective : Pilonidal sinus (PS) is a chronic intermittent disease. There are numerous surgical treatment procedures that have been previously reported, yet none have been proved to be ideal. The main issues concerning the surgical treatment of PS are simplicity and cost-effectiveness. This study is designed to research the possibility of decreasing operation costs in the excision and simple primary closure technique of PS by omitting subcutaneous suture usage. Materials and methods : 152 male patients with chronic PS were included in the study. All patients were treated with excision and simple primary closure technique and randomized into two groups. Group-I (n = 74) received subcutaneous closure with 2/0 polyglactin sutures, but Group-II (n = 78) did not. Wound edges were re-approximated by using deep interrupted matress 0 no polypropylene sutures in both groups. Results : In Group-I; overall 7 (9.5%) early complications were noted; 2(2.7%) wounds broke down and 5 (6.7%) experienced superficial wound infections. Any late wound complications were noted. A total of 98 polypropylene and 104 polyglactin sutures were used. In Group-II; overall 5 (6.4%) early wound complications were noted; 3 (3.8%) had wound dehiscence and 2 (2.6%) developed superficial wound infections. Also, 1 (1.3%) late wound complication (wound dehiscence) occurred. Overall 104 polypropylene sutures were used. Conclusion : Excision and simple primary closure is a simple and cost effective surgical procedure in the treatment of PS. Omitting the use of subcutaneous sutures makes the procedure simpler and decreases the operation costs.

Hepatocellular carcinoma in the common bile duct “Hepatocellular Carcinoma”

To the editor: Hepatocellular carcinoma (HCC) is the most common primary epithelial tumor of the liver that originates from hepatocytes. It has been stated that cirrhosis is a predisposing factor for development of HCC as 80% of the cases are associated with cirrhosis (1). Some sporadic HCC cases arising from extrahepatic tissue mostly localized around the liver parenchyma or biliary system have also been reported (2). Here, we present a HCC first diagnosed in the extrahepatic bile ducts causing obstructive jaundice. A 75-year-old male patient was admitted to our hospital with complaints of epigastric fullness, pain, nausea, vomiting and dark-yellowish urine for one week. Except for alcoholism, his medical history was uneventful. During the physical examination, a mild hepatomegaly was noted exceeding the right costal margin nearly 2 cm with remarkable splenomegaly. Blood tests revealed direct bilirubine 1.77 mg/dl (0.1–0.2 mg/dl), indirect bilirubine: 2.88 mg/dl (0.2– 0.8 mg/dl), AST: 51(5–40 U/l), ALT: 27(5–40 U/l), ALP: 312(38–155 U/l), GGT: 95(10–49 U/l), AFP: 0 (o 11.3 IU/l), CA-19-9: 240(o 39 U/ml). The other blood test results were within normal limits. Contrastenhanced CT and US of the abdomen showed dilated intrahepatic bile ducts, splenomegaly and dysmorphic liver with no mass. ERCP revealed a 1.5–2 cm mass occluding almost completely the common hepatic duct just below the hilar bifurcation. The main bile duct was normal in shape and diameter. Several biopsy materials were collected, which failed to identify malignancy. On laparotomy, intraoperative USG showed slightly diffuse dilation of intrahepatic bile ducts, but no tumoral lesion within the liver. Meanwhile a hyperechoic lesion without posterior shadow was noted at the hilar bifurcation. Upon examination, no continuation could be noted between the lesion described with USG and the main liver. Patient was given an extrahepatic bile duct exploration, and a 20 15 mm polypoid mass with 0.6 mm pedicle at the bifurcation of the right and left extrahepatic bile ducts was detected (Fig. 1). The main bile duct was resected over a Roux-en-Y hepaticojejunostomy. Postoperative histological examination of the resected materials revealed a tumor consisting of atypical hepatocytes with moderate polymorphism and mitosis and any normal hepatocyte (Fig. 2). Any normal liver architecture has been reported. Immunohistochemistry examination of the mass showed that tumor cells were not stained with CK7, CK20, chromogranin, AFP and CEA but had weak membranous immunoreactivity with CD10. Patient was diagnosed as having HCC arising from extrahepatic origin, which was localized in the common bile duct. Patient was discharged on the 10th postoperative day and was asked to come back every three months for a checkup. In the sixth postoperative month, the patient was readmitted with clinical deterioration, massive ascites and dyspnea. Liver failure findings were apparent with multiple intraparenchymal lesions in the liver detected with CT (Fig. 3). The patient died due to decompensation of his hepatic failure on the 10th day after his second admission. HCC is a primary epithelial liver malignancy, which usually arises from intrahepatic hepatocytes. Accompanying cirrhosis, major vascular or biliary invasion and extrahepatic lymph node metastasis most often indicate a poor prognosis. Biliary invasion usually leads to tumor migration and obstruction of the main bile ducts. Icteric-type HCC is a clinical condition, first described in 1975 by Tanoue and colleagues (3, 4), which is initially characterized by jaundice resulting from either invasion or compression of the primary tumor to the bile duct wall (5). This group of patients also has primary tumor focus in the mother liver that can be shown with conventional diagnostic tests. Patients with invaded bile ducts and jaundice are usually admitted with a significantly high a-fetoprotein (AFP) level and severe cholangitis (6). Ectopic liver tissue (ELT) is a very rare condition, which is usually diagnosed using laparoscopy, laparotomy or autopsy. Incidence has been given as 0.47% in a laparoscopy series. Arakawa and colleagues (2, 7, 8) reported 22 patients with HCC in the ELT in 1999 with an additional three cases reported after that Arakawa et al. (2) have claimed that even if ELT had its own biliary and portal system, lack of the drainage

Effect of mesalazine, metronidazole and gentamicin on bacterial translocation in experimental colitis.

Background and Aim:  In inflammatory bowel disease it has been established that enteric microorganisms are present in the final stage of the active inflammatory process. The purpose of the present study was to investigate the effects of mesalazine, and metronidazole–gentamicin combination, on bacterial translocation in an animal colitis model.