Ekrem Ünal

Effect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients.

AbstractPURPOSE: Living with a permanent colostomy significantly diminishes a patient’s quality of life. However, little is known about its influence on worship patterns in Muslims. Therefore, the aim of this study was to assess the quality of life in Muslim patients after surgery for rectal carcinoma, especially with respect to religious worship. METHODS: We studied 178 patients who had undergone curative surgery for colorectal carcinoma. The patients fell into three groups based on the type of surgery they underwent: abdominoperineal resection (n = 75), sphincter-saving resection (n = 51), and anterior resection including sigmoid colectomy (n = 52). Quality of life was measured with the Medical Outcomes Study Short Form 36 Health Survey and a questionnaire that asked participants about their work responsibilities, sexual life, and religious worship. RESULTS: The scores for all eight subscales of the Short Form 36 in the abdominoperineal resection group were significantly poorer than those in the sphincter-saving resection and anterior resection groups (P < 0.001). In addition, social life and work responsibilities were significantly more affected in the abdominoperineal resection group than in the other two groups (P < 0.001). A significantly (P < 0.001) greater number of patients in the abdominoperineal resection group stopped praying daily (either alone or in a mosque) and fasting during Ramadan. CONCLUSION: Two aspects of religious worship (praying and fasting) were significantly impaired in the Muslim patients who had a stoma as a result of sphincter-sacrificing surgery. To improve quality of life in these patients, religious issues as they relate to the presence of a stoma should be discussed during preoperative counseling, the informed consent process, and counseling with local religious authorities.

Influence of post‐transplant recombinant human granulocyte colony‐stimulating factor administration on peritransplant morbidity in patients undergoing autologous stem cell transplantation

Summary. This study evaluated of the effect of post‐transplant recombinant human granulocyte colony‐stimulating factor (rhG‐CSF) administration on the parameters of peritransplant morbidity. Three sequential and consecutive cohorts of 20 patients each received either post‐transplant rhG‐CSF at a dose of 5 µg/kg/d i.v. in the morning, starting on d 0, d 5, or no rhG‐CSF. Patients who received rhG‐CSF starting on d 0 and 5 recovered granulocytes more rapidly than those not receiving rhG‐CSF (P < 0·001 for ANC ≥ 0·5 and 1 × 109/l). RhG‐CSF administration was not significantly associated with more rapid platelet engraftment. RhG‐CSF administration starting on d 0 and 5 was significantly associated with a decreased duration of fever (P = 0·002 and 0·001 respectively), antibiotic administration (P < 0·001 and 0·006 respectively) and shorter hospitalization (P < 0·001 and 0·001 respectively) compared with the reference group. There was no difference between the d 0 and d 5 arms regarding the parameters of peritransplant morbidity. In conclusion, rhG‐CSF administration was associated with a faster granulocyte recovery, shorter hospitalization, and shorter period of fever and non‐prophylactic antibiotic administration. This study also showed that starting rhG‐CSF administration on d 5 may be as effective as d 0 on the clinical outcome and may be an economical approach in routine clinical practice in this cost‐conscious era.

Lupus mastitis is not a surgical disease.

Abstract:  A 23‐year‐old woman with a 2‐year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound‐guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.

Aortobifemoral Graft Causing Complete Intestinal Obstruction in a Patient with Behçet’s Disease: Report of a Case

A 50-year-old man with Behçet’s disease and a history of aortobifemoral (ABF) bypass grafting for an abdominal aortic aneurysm was admitted to our Emergency Room with ileus. Upon exploration we found that the ABF graft was occluding the jejunal passage. To the best of our knowledge this is the first such case ever to be reported.

Mide kanseri cerrahisinde fast-track ve geleneksel yöntemlerin karşılaştırılması

GIRIŞ Mide kanseri sik karsilasilan bir hastaliktir. Dunyada her yil yaklasik bir milyon yeni olgu teshis edilmektedir (1). Billroth tarafindan ilk basarili gastrektominin yapildigi 1881 yilindan bu yana cerrahi mide kanserinin kuratif tedavisinde hala tek umuttur. Geleneksel elektif gastrik rezeksiyon %10-45 komplikasyon orani ve 8-13 gunluk postoperatif hastanede yatis suresiyle uygulanmaktadir (2-5) . Mide kanser cerrahisinde fasttrack cerrahi (FTC) uygulamalarla ilgili, literaturde cok az veri bulunmaktadir. Tek prospektif randomize calisma Wang ve ark. (6) ait olup FTC’nin mide kanser cerrahisine guvenle uygulanabilecegi rapor edilmistir.

Myofascial necrosis as a complication of central venous catheterization in a patient with paroxysmal nocturnal hemoglobinuria.

tal syndrome resulting in high median nerve palsy. Fasciotomy was performed after platelet and erythrocyte replacement (Fig. 1). During the intra-operative exploration, subcutaneous tissue and biceps muscle appeared necrotic and the median nerve was observed to be compressed by edematous and fibrotic tissue. Specimens for bacterial cultures were collected. The patient had a continuous fever in the post-operative period. In this period, the patient’s neutrophil count was 1200/mm3. Although the bacterial culture reports were negative, the empiric antibiotic was changed and one dose of 400 mg of teicoplanin, three doses of 1000 mg of meropenem and three doses of 900 mg of clindamycin were administered daily. After a 5-day post-operative period, surgical debridement of totally necrotic parts of the skin, subcutaneous tissue and muscles of the chest and left arm was performed (Fig. 2). Post-anesthesia respiratory failure occurred and the patient was intubated and supported with mechanical ventilation and inotropic agents. Three days later the patient could be extubated and had no need of ventilation support and inotropic agents. Two more surgical debridements were carried out in the following month. Thereafter the patient was referred to the plastic surgery department for a skin graft. CVC is frequently required for the treatment and hemodynamic monitorization of critically ill patients hospitalized in intensive care units. However, this procedure can lead to some serious complications. These complications may be infectious, mechanical or Myofascial necrosis as a complication of central venous catheterization in a patient with paroxysmal nocturnal hemoglobinuria