Erol Kisli

The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses.

PURPOSE To study the diagnostic value of diffusion-weighted imaging (DWI) in soft tissue abscesses. MATERIALS AND METHODS Fifty patients were included in this study who were thought to have soft tissue abscess or cystic lesion as a result of clinical and radiological examinations. Localisations of the lesions were: 1 periorbital, 3 breast, 14 intraabdominal, and 32 intramuscular lesions. After other radiological examinations, DWI was performed. The signal intensity values of the lesions were evaluated qualitatively according to the hyperintensity on b-1000 DWI, using 1.5 T MR system. All of the lesions were aspirated after DWI, and detection of pus in the aspiration material was accepted as gold standard for the diagnosis of abscess. RESULTS In 38 of the 50 patients, hyperintensity was obtained on diffusion-weighted images. False-positive results were maintained in 2 of these patients, and true-positive results were maintained in 36 of them. In 11 of the 50 patients, hypointensity was visualised on diffusion-weighted images. False-negative results were maintained in 3 of these patients, and true-negative results were maintained in 8 of them. An abscess which was seen on post-contrast conventional MRI could not be seen on DWI, and this was regarded as false-negative. CONCLUSION The sensitivity and specificity of diffusion-weighted images for detecting soft tissue abscesses were found to be 92% and 80%, respectively. DWI has a high diagnostic value in soft tissue abscesses, and is an important imaging modality that may be used for the differentiation of cysts and abscesses.

Levels of matrix metalloproteinase-1 and tissue inhibitors of metalloproteinase-1 in gastric cancer

AIM To evaluate the levels of preoperative serum matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gastric cancer. METHODS One hundred gastric cancer patients who underwent gastrectomy were enrolled in this study. The serum concentrations of MMP-1 and TIMP-1 in these patients and in fifty healthy controls were determined using an enzyme-linked immunosorbent assay. RESULTS Higher serum MMP-1 and TIMP-1 levels were observed in patients than in controls (P < 0.001). Serum MMP-1 and TIMP-1 levels were positively associated with morphological appearance, tumor size, depth of wall invasion, lymph node metastasis, liver metastasis, perineural invasion, and pathological stage. They were not significantly associated with age, gender, tumor location, or histological type. CONCLUSION Increased MMP-1 and TIMP-1 were associated with gastric cancer. Although these markers are not good markers for diagnosis, these markers show in advanced gastric cancer.

Effect of Dexmedetomidine IV on the Duration of Spinal Anesthesia with Prilocaine: A Double-Blind, Prospective Study in Adult Surgical Patients

BACKGROUND The duration of spinal anesthesia with prilocaine has been poorly documented and no English-language study has been published regarding the effects of dexmedetomidine on the duration of anesthesia with spinal prilocaine. OBJECTIVE The aim of this study was to assess the effects of dexmedetomidine IV on the duration of action of prilocaine and its associated adverse events (AEs) in spinal anesthesia. METHODS In this double-blind, prospective study, patients classified as American Society of Anesthesiologists grade I to II who were to undergo lower abdominal, anorectal, or extremity surgery with a spinal anesthetic were assigned to 1 of 2 groups. All patients were administered prilocaine 2% for spinal anesthesia. Within 10 minutes after spinal anesthesia was initiated, group 1 received a loading dose of dexmedetomidine 1 μg/kg IV, followed by a maintenance dose of 0.4 μg/kg · h for 50 minutes; group 2 (control) received the same amount of physiologic saline in the same time frame. Mean arterial pressure (MAP), heart rate (HR), duration of sensory and motor blockade, and sedation scores were tracked. Patients were observed for 4.5 hours after surgery, with follow-ups occurring up to 96 hours after surgery. RESULTS Eighty-three patients were assessed for study inclusion, 23 of whom were excluded. Sixty patients (42 men, 18 women; mean [SD] age, 40.56 [16.86] years) were included in the study. MAP was similar in the 2 groups throughout the study. Mean (SD) HR was significantly lower in group 1 compared with group 2 at 20 minutes (70.43 [19.28] vs 77.63 [18.14] beats per minute, respectively; P = 0.02). The mean (SD) duration of the persistence of sensory anesthesia (ie, the time required for the maximal level of anesthesia to regress 2 dermatomes) was significantly longer in group 1 compared with group 2 (148.33 [21.18] vs 122.83 [18.73] minutes; P < 0.001). The mean (SD) time to complete abolishment of motor blockade was also significantly longer in group 1 than in group 2 (215.16 [25.10] vs 190.83 [18.57] minutes; P < 0.001). The average sedation score in group 1 was significantly higher than in group 2 (P < 0.001) during anesthesia. Significantly more patients in group 1 required atropine than those in group 2 (9 vs 2 patients; P < 0.001) to treat bradycardia. There was no significant between-group difference in the number of patients who received ephedrine to treat hypotension. One patient in each group reported waist and back pain; 2 patients in each group reported nausea. Shivering occurred in 0 and 5 patients in groups 1 and 2, respectively; the between-group difference in AEs was not statistically significant. Paresthesia, postdural puncture headache, allergic reactions, total spinal anesthesia, urinary retention, or vomiting-AEs commonly associated with spinal anesthesia-were not observed or reported by either group. CONCLUSIONS The results of this study suggest that dexmedetomidine IV significantly prolonged the duration of spinal anesthesia and provided a significantly higher level of sedation compared to placebo in this group of adult surgical patients. The treatment was generally well tolerated in all patients.

Acute pancreatitis, bacterial translocation, and different octreotide regimens: An experimental study

PurposeTo determine the effect of octreotide, octreotide with zinc, levamisole, and misoprostol on the bacterial translocation that develops in rats with acute pancreatitis (AP).MethodsA total of 36 rats were divided into six groups, each consisting of six rats. Only laparotomy was performed on the first group. Acute pancreatitis was performed on the second group. Octreotide was given to the third, fourth, fifth, and sixth groups. Octreotide, octreotide with zinc, levamisole, and misoprostol were given to groups III, IV, V, VI, respectively. Rats were euthanized 48 h after the occurrence of AP. Blood and mesenteric lymph node samples were collected for polymerase chain reaction (PCR). Pancreatic tissue and terminal ileum were obtained for histopathological examinations.ResultsThe severity of pancreatitis and mucosal damage of the terminal ileum was higher in group II than groups I, III, IV, V, and VI, histopathologically (P < 0.05). There wasn’t a significant difference with respect to OA with Zn or L or M and OA group (P > 0.05). A significant difference was found in PCR positivity in blood and mesenteric lymph node between groups I and II (P < 0.05).ConclusionsIn AP, administering octreotide alone significantly prevented the bacterial translocation by preventing mucosal damage. The zinc, levamisole, or misoprostol with octreotide did not influence the results.

Comparison of the analgesic effect of betamethasone and diclofenac potassium in the management of postoperative haemorrhoidectomy pain

Abstract Background : Outpatient postoperative haemorrhoidectomy pain remains a difficult problem. The purpose of this study is to compare the results of the use of betamethasone with diclofenac potassium in postoperative pain following haemorrhoidectomy. Material and methods : Closed haemorrhoidectomy was performed on 40 patients who were diagnosed grade III, grade IV haemorrhoid on physical examination. Patients were divided equally randomized into two groups, prospectively (betamethasone was used for 20 patients and diclofenac potassium was given for 20 patients). A verbal categorical scale was used to evaluate postoperative pain (for pain intensity, none = 0, mild = 1, moderate = 2 and severe = 3). Results : The amount of narcotics required on postoperative first, second and third day were significantly less in the betamethasone group than in the diclofenac potassium group (P < 0.001) (Pearson Chi-Square test). Conclusion : Results indicate that use of betamethasone provides more effective analgesia than diclofenac potassium for postoperative pain management in the haemorrhoidectomy patient.

Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

Meckels diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckels diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckels diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckels diverticulum.

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

Abstract Purpose: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. Patients and methods: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. Results: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. Comment: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Effect of Ginkgo biloba Extract (EGb 761) on the Healing of Left Colonic Anastomoses in Rat

BackgroundThe aim of this study was to assess the effect of Ginkgo biloba extract (EGb 761) on healing of experimental colonic anastomoses in a rat model.MethodsRats were divided into four groups: postoperative day (POD) 3 untreated control group, POD 3 EGb 761 group, POD 7 untreated control group, and POD 7 EGb 761 group. In the oral EGb 761 groups, the agent was given at 9.6 mg daily per orogastric route using a 4-F fine feeding catheter. We measured bursting pressures and hydroxyproline content and histologically examined the resected anastomoses on POD 3 and POD 7.ResultsThe bursting pressures increased more in the EGb 761 group than in the untreated control group on POD 3, but this difference was not statistically significant. Hydroxyproline content was higher in the EGb 761 group than in the untreated control group on POD 3, and this difference was statistically significant. Anastomosis bursting pressure values and hydroxyproline contents were significantly higher in the EGb 761 group than in the untreated control group on POD 7. Histological examination showed greater fibroblastic activity in the EGb 761 group than in the untreated control group on POD 3. There was no significant difference in anastomotic polimorphonuclear leukocyte, mononuclear cells and blood vessel neodevelopment between the POD 3 groups, but there was significant difference in fibroblastic activity and blood vessel neodevelopment between the POD 7 groups.ConclusionsThese results showed us that EGb 761 administration resulted in enhanced stability of colonic anastomoses during the first postoperative week.

Rothmund Thomson Syndrome Associated with Esophageal Stenosis : Report of a Case

Rothmund Thomson syndrome (RTS) is a rare autosomal recessive disorder which is primarily diagnosed by clinical manifestations that include poikiloderma, short stature, sparse hair distribution, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis. Although a few reports have been published on patients with RTS associated with gastrointestinal abnormalities, to our knowledge the case described herein is the first documentation of a patient with RTS having upper esophageal stenosis.

Effects of spinal anesthesia and laryngeal mask anesthesia on mood states during hemorrhoidectomy.

The present study was undertaken to compare the effects of laryngeal mask anesthesia (LMA) and spinal anesthesia on mood states in patients undergoing hemorrhoidectomy. A total of 46 patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids were included in this study. LMA with fentanyl plus propofol was given to 23 patients, and spinal anesthesia with bupivacaine was administered to 23 patients. Mood changes were assessed preoperatively and 2 h postoperatively with the Profile of Mood States (POMS), which consists of 65 questions that are designed to measure 6 identifiable mood states (tension, depression, anger, vigor, fatigue, and confusion). No significant differences were noted between the 2 groups in terms of baseline POMS global and subscale scores, except for scores regarding vigor. No significant mood changes were observed after hemorrhoidectomy in patients who were given LMA; however, an increase in total POMS score was reported in patients given spinal anesthesia. These findings suggest that mood score is affected by spinal anesthesia but not by LMA in patients who are about to undergo hemorrhoidectomy.