Cihat Tetik

Ultrasound-guided laparoscopic resection of pancreatic islet cell tumors.

Pancreatic islet cell tumors represent a diverse group of neuroendocrine lesions. These tumors may be singular or multiple, benign or malignant, sporadic, or part of the constellation of multiple endocrine neoplasia type 1. Tumors such as insulinomas and gastrinomas produce gastrointestinal peptides that lead to diagnosis. Nonfunctioning lesions may be found incidentally or by screening patients at high risk for such tumors. Successful management of patients with pancreatic islet cell tumors relies on accurate localization and sound operative technique. With proper preoperative localization, advanced laparoscopic methods can be used to manage patients with these pancreatic neoplasms. Preoperative localization of pancreatic islet cell tumors was difficult in the past. Standard imaging and localizing modalities, such as computed tomography scanning, magnetic resonance imaging, angiography, transabdominal sonography, and portal venous sampling, yield only 24% to 75% accuracy. Consequently, many biochemically suspected lesions cannot be imaged with current techniques. Decreased tactile sensation of laparoscopy adds complexity to intraoperative identification. Endoscopic sonography and laparoscopic sonography provide accurate preoperative and intraoperative localization to enhance laparoscopic and open resection. The authors treated two patients with islet cell neoplasms using endoscopic sonography to preoperatively visualize the tumors and laparoscopic sonography to guide laparoscopic enucleation. Their approach and difficulties are discussed.

Neuroprotective effects of preischemia subcutaneous magnesium sulfate in transient cerebral ischemia

OBJECTIVE Neurological injury due to transient cerebral ischemia is a potential complication of cardiovascular surgery. The neuroprotective effect of magnesium, when given subcutaneously before the ischemia, was assessed in a rat model of transient global cerebral ischemia. METHODS Thirty-six male Wistar albino rats were included to this randomized, controlled, prospective study. In 24 animals, ischemia was induced with four-vessel occlusion technique with the duration of 15 min. MgSO4 was given 600 mg/kg subcutaneously 48 h before the procedure in group 1 (n = 12). Similar volume of saline solution was used in animals of control group (group 2, n = 12). The animals in group 3 (sham group, n = 12) were anesthetized and subjected to operative dissections without vascular occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 30 min of reperfusion. Their neurological outcome had been clinically evaluated and scored up to 4 days postischemia. The intergroup differences were compared. Then the animals were sacrificed and their brains were processed for histopathological examination. RESULTS In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 5 +/- 3% of the baseline in all ischemic animals. This was followed by a gradual return to 87 +/- 10% and 83 +/- 8% of the initial amplitude after 30 min of reperfusion in group 1 and group 2, respectively (P > 0.05). The average neurological score was significantly higher in group 1 than in group 2 at 48, 72 and 96 h after the ischemic insult (P < 0.05). Histological observations were clearly correlated with the neurological findings. CONCLUSION The results suggest that subcutaneous MgSO4 reduces cerebral injury and preserves neurologic function when given two days before the transient global ischemia in rats.

Why is my design not working? The role of student factors

This paper brings together the findings of a series of studies that explored the impact of curricular changes on students’ approaches to learning. The findings, which were initially surprising, are confirmed by the identification of similar patterns across four different medical educational programmes within Australia and Sri Lanka. The four studies reported in this paper utilised similar methods to examine how students’ approaches to learning change in response to ‘deep‐approach‐enhancing’ educational programmes. The studies used the R‐SPQ‐2F questionnaire to measure students’ approaches to learning scores before and after students had experienced ‘deep‐approach‐enhancing’ educational programmes. Students were asked to use a unique identifier, which allowed comparison of each individual student’s approach scores before and after the relevant educational programme. Cluster analysis was performed on the data, and this revealed four patterns of change of deep approach scores. The patterns were similar (although not identical) across the four studies. A significant finding was that while a proportion of students responded by changing to deeper approaches (as expected), a similar proportion of students responded by changing to more surface approaches. The finding that a significant proportion of students adopted surface approaches in response to a ‘deep‐enhancing’ context is of some concern. This paper focuses on this subgroup of students, and explores possible factors that might relate to this unexpected response. From a theoretical perspective, the findings provide a new insight into the current theory of students’ approaches to learning by demonstrating a complex pattern of student response. The findings that a subgroup of students respond in ways contrary to that suggested by current educational theory, and the identification of features that characterise this subgroup are significant contributions to the literature. From a practical perspective, the findings have significant implications for designers of educational programmes who are aiming to foster deep approaches in their students.

Comparison of local and spinal anesthesia techniques in inguinal hernia repair

Abstract The aim of this study is to evaluate the safety and effectiveness of local anesthesia in surgical treatment of inguinal hernia, compared with spinal anesthesia. Ninety-six patients who underwent hernia repair between December 1999 and April 2002 were included prospectively. The patients were assigned randomly to two groups according to their admission numbers. Group I included 47 patients undergoing surgical treatment of inguinal hernia with local anesthesia; Group II included 49 patients having inguinal hernia repair with spinal anesthesia. The early complication rates, length of the hospital stay, and costs were evaluated prospectively. Early complication rates were 14.8 and 32.6%, respectively; there was no significant difference between the two groups. The length of hospital stay and cost were significantly lower in Group I than in Group II. In conclusion, local anesthesia is a safe and cost-effective method in the treatment of inguinal hernia.

Efficiency of ultrasound in the detection of the viability of hydatid cysts in the liver.

The aim of the present study was to establish the relationship between viability of the hydatid cyst and its ultrasonic appearance (Gharbi classification). To evaluate cyst viability, the criteria that were reported by the World Health Organization in 1982 for both the microbiological evaluation of the cystic fluid and the pathological evaluation of the cyst wall were used. In this study, the possibility of being viable was high in Type I cysts; the possibility of being dead was high in Type IV cysts. It is concluded that there is a relationship between ultrasonic appearance and the evolution of hydatid cysts.