Erdoğan Sözüer

Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts.

Abstract.Abstract.Purpose: The most common complication of hydatid liver cysts is spontaneous rupture into the biliary tract. This study was conducted to evaluate the surgical management of spontaneous intrabiliary rupture of a hydatid liver cyst in 41 patients.Methods: The preoperative diagnosis was confirmed by ultrasound in all 41 patients, 37 of whom were jaundiced.Results: According to Gharbis classification, 39% of the cysts were type III and they ranged from 3 to 18 cm in diameter, with a mean diameter of 9 cm. The mean total bilirubin and alkaline phosphatase values were 6.3 mg/dl and 450 IU, respectively. Partial cystectomy, cholecystectomy, and common bile duct exploration were performed in all patients. In seven patients, the visible biliary duct within the cyst cavity was sutured with 2/0 silk. Intraoperative cholangiography was performed in all patients, and choledochoscopy was performed in 11 patients. A T-tube was inserted after the biliary tract content was thought to have been totally cleaned out in 38 patients (93%), and a choledochoduodenostomy was performed in 3 patients (7%). An external biliary fistula developed in five patients, persisting for 11–25 days. The fistulae healed within a mean period of 5 days after endoscopic sphincterotomy (EST). For patients without a fistula the mean hospitalization time was 8 days and there was no mortality.Conclusion: These results suggest that when a hydatid liver cyst ruptures into the biliary tract, common bile duct exploration should be conducted using intraoperative cholangiography and choledochoscopy. If the biliary tract is cleaned of all cystic content, T-tube drainage should be sufficient, but EST is an effective technique for treating persistent extended external biliary fistulae.

The correlation of the D-dimer test and biphasic computed tomography with mesenteric computed tomography angiography in the diagnosis of acute mesenteric ischemia

BACKGROUND Early diagnosis is the main factor to improve the outcome of acute mesenteric ischemia (AMI). The goal of this study was to assess the correlation of the D-dimer test and biphasic computed tomography (CT) with mesenteric CT angiography for the diagnosis of AMI. METHODS Selected consecutive patients with a clinical suspicion of AMI were admitted to the study. Blood samples were taken before biphasic CT with mesenteric CT angiography examination. RESULTS The sensitivity and specificity values of biphasic CT with mesenteric CT angiography were 92.9% and 89.5%, respectively. The sensitivity and specificity of D-dimer testing for the diagnosis of AMI were 94.7% and 78.6%, respectively. D-dimer levels higher than 3.17 microg fibrinogen equivalent units/mL were more specific (P < .0001) and acted similarly to the biphasic CT with mesenteric CT angiography in the diagnosis of AMI. CONCLUSIONS In the setting of early diagnosis of AMI, the D-dimer test may improve our ability to diagnose patients in whom we cannot use multidetector row CT with CT angiography.

Bleeding due to a medicinal leech bite

This paper reports a case of prolonged bleeding following application of leeches to treat chronic pain. The paper discusses the characteristics of the wounds and possible complication of prolonged bleeding following medicinal leech application. The principles of treatment are also described.

Adult burn injuries in an Emergency Department in Central Anatolia, Turkey: a 5-year analysis

PURPOSE Burn injuries require a multidisciplinary approach. Emergency Departments can play vital roles in the treatment of burns. The purpose of this study is to investigate the epidemiological and clinical characteristics of the adult burn patients admitted to our Emergency Department and to determine the frequency of the patients who were treated on an outpatient basis and discharged from the Emergency Department. PROCEDURE A retrospective review of 314 adult burn patients who presented to the Emergency Medicine Department of Erciyes University Hospital from January 1996 to December 2000. FINDINGS Sixty-four percent of the patients were male. Mean age was 32.9+/-14.7. Ninety-nine patients (32%) had moderate to major burns. The highest numbers of patients were in the 21-30 age group. Flame burns comprised the majority of presentations and admissions (48 and 69%, respectively). Thirteen patients had associated injuries (4%). Eighty-seven patients (28%) were hospitalized, 21 of these died. Death occurred mostly from respiratory failure and sepsis. Domestic accidents were the leading mechanism (63%). CONCLUSION Burns were mostly due to accidents arising from carelessness, ignorance, hazardous traditions and improperly manufactured products. These can be prevented through mass education programs countrywide. Because almost all burn patients present to Emergency Departments first and not all hospitals can employ burn specialists, the patients with minor burns can be treated on an outpatient basis and the treatment of severe burns can be effectively initiated by emergency physicians.

Beneficial Effects of Recombinant Platelet-Activating Factor Acetylhydrolase and BN 52021 on Bacterial Translocation in Cerulein-Induced Pancreatitis

Background: Bacterial translocation (BT) has been suggested to be responsible for the high incidence of infections occurring after acute pancreatitis (AP). The aim of this study was to investigate the effects of the platelet-activating factor (PAF) inactivator, recombinant PAF-acetylhydrolase (rPAF-AH), and the PAF receptor antagonist, BN 52021, in AP. Methods: Forty-eight male Wistar rats were divided into 4 groups: the sham group received saline intraperitoneally every hour for 6 h; the control group received cerulein 50 g/kg i.p. every hour for 6 h; the rPAF-AH group received AP plus rPAF-AH (5 mg/kg i.v. bolus), and the BN52021 group received AP plus BN 52021 (5 mg/kg i.v. bolus). The animals were sacrificed 12 h after the first cerulein injection. Results: Supramaximal cerulein stimulation induced an increase in serum pancreatic enzymes, interleukin (IL)-6, pancreatic edema, and produced histologic evidence of AP. Compared with the control group, the addition of PAF receptor antagonists had a significant effect on serum pancreatic enzymes, pancreatic edema, and the histologic score of the pancreatitis. AP caused significant increases in BT in mesenteric lymph nodes (MLNs), pancreas, liver, spleen and blood. Compared with the control group, both rPAF-AH and BN 52021 decreased BT in the pancreas and blood. In addition, rPAF-AH decreased BT in the MLNs. We also found that PAF receptor antagonists suppressed the elevation in IL-6 levels. Conclusion: PAF antagonists attenuated the severity of experimental AP and reduced pancreatitis-induced BT to distant sites.

Laparoscopy for Diagnosis and Treatment of Acute Abdominal Pain

PURPOSE To evaluate the role of laparoscopy in the diagnosis and treatment of unexplained acute abdominal pain. PATIENTS AND METHODS Fifty-six patients with acute abdominal pain (41 women, 15 men; median age 27) who attended our hospital between July 1996 and July 1999 and in whom a definite diagnosis could not be made by conventional methods underwent diagnostic laparoscopy. RESULTS The laparoscopic procedure was performed under general anesthesia in 43 patients and local anesthesia in 13 patients. The median duration of laparoscopy was 16 minutes. The sensitivity and specificity of diagnostic laparoscopy were found to be 98% and 96%, respectively. The most frequent diagnosis was acute appendicitis (38%). Laparoscopic treatment of the surgical pathology was possible in 36 patients; in seven patients, conversion to laparotomy was necessary. The median postoperative hospital stay was 1 day in the diagnostic laparoscopy group. The median treatment cost was lower in the diagnostic laparoscopy group than in the therapeutic laparoscopy or laparotomy groups. There was no mortality or morbidity in the laparoscopy groups. CONCLUSIONS Laparoscopy is an effective method for the diagnosis and treatment of surgical pathologies in patients in whom the diagnosis cannot be made with physical examination and noninvasive methods.

Ocular trauma in Turkey: a 2-year prospective study

This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3±13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. Information recorded included demographic data, details of the eye injury, whether eye protection was used, and the type, location, and mechanism of injury to the eye. Mechanism of injury was categorized as blunt, sharp, or a combination. The ophthalmologist reported the time that had passed between occurrence of injury and presentation for treatment. Each patient was examined by the ophthalmologist, and findings, diagnosis, and treatment were documented. Of treated patients, 93% were hospitalized, most of whom required surgical treatment. One hundred (48%) injuries were related to blunt trauma and 86 (41%) to sharp device trauma. Only 10 (4%) patients were wearing protective eyewear when injured. Ruptured globe was the most common diagnosis of hospitalized patients and the most frequent cause of this was corneal lesions; subconjunctival hemorrhage was the most common diagnosis among nonhospitalized patients. In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.

Periampullary Adenomyoma: Report of Two Cases

Abstract.Adenomyoma is a rare nonneoplastic lesion of the biliary tract. We report two cases of adenomyoma; one located in the duodenum, and the other located in the ampulla Vateri. Both patients presented with jaundice, and preoperative endoscopic and radiologic procedures could not show whether the tumor was benign or malignant. Despite intraoperative frozen section in one patient, the diagnosis of adenomyoma was not confirmed until after pancreaticoduodenectomy.

The Effect of Interleukin-10 on Acute Pancreatitis Induced by Cerulein in a Rat Experimental Model

To investigate whether interleukin-10, a potent anti-inflammatory cytokine, could have a therapeutic effect on rats on that were made pancreatitis by cerulein. Thirty Wistar Albino rats were randomized into sham, pancreatitis, and therapy groups (n = 10 in each). Nothing was applied to the sham group; pancreatitis by injecting cerulein (50 μ g/kg/h) was induced in the pancreatitis and therapy groups. Interleukin-10 (10.000 U) was injected at 1 and 4 h after pancreatitis inductions in the therapy group. The rats were sacrificed at postoperative hour 24. The following parameters were investigated: the leukocyte count, blood glucose, amylase, lipase and tumor necrosis factor-alpha levels in the blood samples; histopathological search, and wet/dry weight ratios of the pancreas tissues. The ratio of wet/dry pancreatic tissue weight, serum tumor necrosis factor-alpha, amylase and lipase levels, and histologic damage scores in the pancreatitis and therapy groups were significantly higher when they were compared with the sham group (p <. 01). However, all of these values were significantly lower in the therapy groups than in the pancreatitis group (p <. 01). Interleukin-10 decreases pancreatic tissue injury induced by cerulein-induced pancreatitis in rats. Nevertheless, more experimental studies are needed to compare endogenous interleukin-10 with exogenous interleukin-10 effects before clinical usage of this drug.

Recurrent liver hydatid disease: when does it become symptomatic and how does one diagnose it?

BACKGROUND Echinococcosis is a zoonotic disease that mainly occurs in sheep-grazing areas. Recurrence of the disease and its diagnosis are relatively new areas of investigation due to the limited number of cases. The aim of this study was to evaluate the diagnosis of the symptomatic recurrent liver hydatid disease and the efficacy of abdominal ultrasonography (US). MATERIALS AND METHODS Between 1988 and 2006, 412 patients with hydatid cyst of the liver were operated at Erciyes University Medical Faculty. We have considered a growing cyst at the original operative site or at the neighboring hepatic tissue as recurrence and investigated 38 of them for the recurrence of the disease (9.2%). RESULTS The recurrence usually occurred after 2 years. The majority of the cases were Types 2 and 3 (24 cases; 8 were Type 4 and 6 were Type 1) according to Gharbi classification. In 35 patients with recurrent disease approved after surgical exploration, US was successful in preoperative diagnosis (100%). Overall, the recurrence was demonstrated correctly by means of US in 35 patients (92.1%), and 23 of 26 patients (88.4%) were correctly diagnosed with the use of computed tomography. In our study, in the first 2 years after the operation, the success rate of US examination was 72.7%. The success rate of US rose up to 100% when the frequency of recurrence is highest. CONCLUSION Beyond 2 years after surgery, US examination alone might be enough for the diagnosis of symptomatic recurrent liver hydatid disease in patients with the suspicion of recurrence. Postoperative early US profile and annual US examination must be performed for at least 5 years to prevent misinterpretation in doubtful cases.