Erkan Ozturk

Preoperative and postoperative administration of hyperbaric oxygen improves biochemical and mechanical parameters on ischemic and normal colonic anastomoses.

Colonic anastomotic leaks are a major postoperative complication, causing increased mortality and morbidity. Tissue ischemia is one of the most important factors that disrupt anastomotic healing. It is possible to reverse inadequate tissue oxygenation by using increased atmospheric pressure and hyperoxia, which are obtained from hyperbaric oxygen treatment (HBO). Our aim was to investigate the effects of preoperative and postoperative HBO treatment on normal and ischemic colonic anastomoses in rats. Eighty male Wistar Albino rats, weighing between 180 and 240 g, were divided into 8 equal groups. A 1-cm segment of left colon was resected 3 cm proximal to the peritoneal reflection in all groups and colonic anastomosis was performed. In groups 2, 4, 6 and 8, colonic ischemia was established by ligating 2 cm of mesocolon on either side of the anastomosis. Control groups (1 and 2) received no HBO. HBO treatment was given preoperatively in groups 3 and 4, postoperatively in groups 5 and 6, and both preoperatively and postoperatively in groups 7 and 8. HBO treatment was applied for 2 days in the preoperative period and 4 days in the postoperative period. Relaparotomy was performed on postoperative day 5 and a perianastomotic colon segment 2 cm in length was excised for detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. HBO treatment increased tissue hydroxyproline levels in all groups, and this difference was significant in normal anastomosis groups receiving preoperative HBO compared to controls (p =. 013 for group 1 vs. group 3; p =. 023 for group 1 vs. group 5). This improvement was more evident in ischemic and normal groups treated by administration of combined pre- and postoperative HBO (p =. 021 and p =. 013). HBO treatment also increased the mean bursting pressure values in all groups, and again, a statistically significant increase was noted in the ischemic groups compared to controls (p =. 002 for group 2 vs. group 6; p =. 001 for group 2 vs. group 8). Histopathological evaluation of anastomotic line fibrosis was not found to show significant differences between the groups. Adequate tissue oxygenation is the main factor in wound and anastomosis healing. HBO treatment has a positive effect on biochemical and mechanical parameters of ischemic and normal colon anastomoses in rats. It is possible to see this effect more clearly with combined HBO treatment applied before and after ischemic anastomosis.

Preoperative administration of oral carbohydrate-rich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance

OBJECTIVE Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR. METHODS Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated. RESULTS Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups. CONCLUSION Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.

Combination of preoperative ultrasonographic mapping and radioguided occult lesion localization in patients with locally recurrent/persistent papillary thyroid carcinoma: a practical method for central compartment reoperations.

Purpose: To improve the surgical success and reduce the complication rates, we combine our routine preoperative ultrasound (US) mapping technique with radioguided occult lesion localization (ROLL) in patients with papillary thyroid cancer recurrences in central compartment. Materials and Methods: In the morning of surgery, biopsy proven recurrent/persistent tumoral lesions were plotted on a sketch and injected with Tc-99m labeled macroaggregated albumin under US guidance. Thyroid bed exploration was carried out based on the location of biopsy proven lesion with the guidance of intraoperative gamma probe and neck map. The lymphoadipose tissues showing high count rates were resected and labeled separately for histopathologic study. Results: Despite extensive scarring in some patients probe safely guided to lesions. Noninjected tumor foci were searched and successfully resected in the light of neck map that showing topographic relation of injected and noninjected lesions. Among total of 41 excised lesions, 28 metastatic foci ranging from 3 to 38 mm in largest diameter were recognized at final histologic examination. Combination of preoperative mapping with ROLL was found helpful by the operating surgeons in all patients, respectively. Except 2 patients with known distant metastases, undetectable thyroglobulin levels were reached 6 weeks after surgery. Conclusions: The use of preoperative US-mapping with ROLL in patients with nonpalpable recurrent/persistent papillary thyroid cancer in central compartment is technically safe and effective method. Combination of techniques provides better information about topographical relations of recurrent/persistent lesions during surgery.

Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial

AIM This paper is a report of a study conducted to compare the effects of two different oxygen delivery methods on both patient peripheral oxygen saturation and patient satisfaction. BACKGROUND One of the most serious problems encountered in the early postoperative period is hypoxemia. Giving oxygen to patients in the perioperative period reduces the incidence of hypoxemia. Oxygen is generally delivered to patients through oxygen masks or nasal cannulae. Previous studies have shown that face masks and nasal cannulae are effective in the early postoperative period. METHOD A randomized trial was conducted between 2007 and 2008 with patients undergoing thyroidectomy. In the early postoperative period, 5 L/minute of oxygen was given to patients via an oxygen mask (n = 53) or nasal cannulae (n = 53). Peripheral oxygen saturation were measured by pulse oxymeter every 5 minutes for a 30-minute period. The Postoperative Nausea Vomiting Scale was used and patient satisfaction was evaluated using a 10-point scale. RESULTS Average peripheral oxygen saturation for the nasal cannulae group was statistically significant higher than that in the mask group. This difference arose from more frequent removal of the oxygen mask than the nasal cannulae by patients and healthcare professionals. Average satisfaction scores for patients in the nasal cannulae group were statistically significantly higher than those in the mask group. CONCLUSION During the early postoperative period, using nasal cannulae for patients undergoing thyroidectomy increases oxygenation.

The value of serum fibrinogen level in the diagnosis of acute appendicitis

BACKGROUND The aim of this study was to investigate the importance of serum fibrinogen level in the diagnosis of acute appendicitis. METHODS This study was performed on 201 patients who admitted to our clinic. Symptoms, signs, duration of symptoms, and laboratory indicators of appendicitis were recorded, in keeping with the Alvarado score for acute appendicitis. The ultimate diagnosis was based on histopathological results. Serum fibrinogen levels were detected before surgery. The sensitivity, specificity, and predictive values of single test and test combinations were calculated at different cut-off levels. RESULTS During the study period, 201 patients underwent surgery for suspected acute appendicitis. Appendicitis was confirmed in 179 (89%) patients. The mean age was 24.8±7.7 (range, 20-57) years, and 154 (76.6%) patients were male and 47 (23.4%) female. The best diagnostic cut-off point for fibrinogen was found at 245.5 mg/dl, for white blood cells (WBC) at 11,900x109/L and for Alvarado score at 7. CONCLUSION The use of fibrinogen blood level may be a new diagnostic acute-phase reactant in the diagnosis of acute appendicitis. The formulation of a triple test is recommended as criteria in deciding emergency surgery or observation.

The effects of hyperbaric oxygen therapy on experimental colon anastomosis after preoperative chemoradiotherapy.

The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.

A low cost training phantom model for radio-guided localization techniques in occult breast lesions

Radio‐guided localization (RGL) for identifying occult breast lesions has been widely accepted as an alternative technique to other localization methods, including those using wire guidance. An appropriate phantom model would be an invaluable tool for practitioners interested in learning the technique of RGL prior to clinical application. The aim of this study was to devise an inexpensive and reproducible training phantom model for RGL. We developed a simple RGL phantom model imitating an occult breast lesion from inexpensive supplies including a pimento olive, a green pea and a turkey breast. The phantom was constructed for a total cost of less than

Lightning strike: an unusual etiology of gastric perforation

20 and prepared in approximately 10 min. After the first models construction, we constructed approximately 25 additional models and demonstrated that the model design was easily reproducible. The RGL phantom is a time‐ and cost‐effective model that accurately simulates the RGL technique for non‐palpable breast lesions. Future studies are warranted to further validate this model as an effective teaching tool. J. Surg. Oncol. 2015; 112:449–451.

The accuracy of intraoperative frozen section analysis of sentinel lymph nodes in patients with breast cancer

Lightning strike is an unusual form of trauma in terms of being one of the leading causes of death from natural phenomenon. Lightning strike can cause severe damage to many systems and results in a high mortality. The most common cause of death in the lightning strike victim is cardiopulmonary arrest. The most vulnerable subjects for lightning strike are individuals who work in open fields, farmers, and swimmers. The cardiac and neurological injuries are the most serious injuries. Burns, tinnitus, blindness, and secondary blunt trauma have also been reported. Gastrointestinal complications have been documented very rarely. In this study, we present a case of gastric perforation after lightning strike. No report related to gastric perforation caused by lightning strike has been identified in the literature.

Kidney Preserving Resection of Leiomyosarcoma with Reconstruction of Left Renal Vein: Case Report

Background: The biopsy of sentinel lymph nodes (SLNs) has widely replaced conventional axillary lymph node dissection (ALND) for assessing the axillary lymph node (LN) status. Rapid intraoperative frozen section (FS) analysis of SLNs enables surgeon to perform ALND during the same operative procedure. However, there is an ongoing controversy regarding the accuracy and usefulness of FS for the evaluation of SLNs. The aim of the study was to investigate the accuracy of FS analysis in the management of patients with breast cancer. Patients and Methods: Between 2007 and 2014, 214 breast cancer patients who underwent SLN biopsy procedure with intraoperative FS were included in this retrospective study. The SLNs were examined using standard FS procedures, and each section was stained with hematoxylin and eosin (H and E) only. The remaining tissues were then further sectioned and examined with H and E postoperatively. The results of FS and permanent sections were compared (the sensitivity, specificity and accuracy of FS were calculated). Results: FS analysis detected LN metastases in 50 patients, while the permanent histopathologic examination detected metastases in another 9 patients. The sensitivity of FS for all kinds of metastases was 84.7%, but it reached up to 98% for macrometastases, and the specificity was 100%. FS allowed immediate completion of ALND in 50 patients (96%) with positive SLNs, and second-step surgery was only performed in 2 patients with discordant FS results. Conclusion: FS examination of SLNs is a reliable and safe procedure for the diagnosis of LN metastasis. FS provides immediate completion of ALND in case of metastatic disease in the SLNs.