Faruk Aksoy

Effects of diphenhydramine HCl and methylprednisolone in the prevention of abdominal adhesions

OBJECTIVE The purpose of this study was to determine the effects of diphenhydramine hydrochloride and methylprednisolone in peritoneal adhesions. MATERIALS AND METHODS Forty-eight male rats were used in the study. The rats were anesthetized by 5 mg/kg ketamine hydrochloride. After opening the abdomen, 10 longitudinal incisions of 2 to 3 cm in length were made on the right parietal peritoneum, and a 2 cm(2) peritoneal layer was excised from the left abdominal wall. The abdomen was closed with 3/0 silk suture. Group I was the control group, group II was given 10 mg/kg diphenhydramine intravenously, group III was given 20 mg/kg methylprednisolone intravenously, and group IV was administered both of the drugs in the above doses. A blood sample of 2 mL was taken from the rats on the 14th day after the operation. The animals were then sacrificed. The abdomen was opened and abdominal adhesions were examined. A tissue sample of 1 g was taken from the abdominal incision line. Albumin, zinc, and hemoglobin levels and leucocyte counts in the blood were determined as well as hydroxyproline levels in the tissue. RESULTS Numbers of adhesions were as follows: 9 in group I, 3 in group II, and 2 in group III. No adhesion was observed in group IV. Albumin, zinc, and hemoglobin levels and leucocyte counts were found to be similar in all groups. Hydroxyproline levels in the tissue were significantly lower in groups III and IV than in groups I and II (P <0.05). CONCLUSIONS Diphenhydramine and methylprednisolone reduced postoperative adhesions significantly in rats. Further investigations are needed in order to use these drugs as antiadhesive agents in humans.

The effects of different hernia repair methods on postoperative pain medication and CRP levels.

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 ± 41.6 mg/L), Lichtenstein (138.4 ± 72.5 mg/L), and Bassini repair (137.2 ± 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 ± 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 ± 189.1 mg), Bassini (303.2 ± 173.7 mg), and Lichtenstein (253.9 ± 129.3) procedures compared with 196.6 ± 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.

A New Seton Type for the Treatment of Anal Fistula

In this retrospective study, our aim was to introduce an industrial synthetic material that can be used as a seton and then to present the results of complicated anal fistula cases treated with this different sort of seton. Between 1997 and 2005, 32 patients (aged 27–63 years) with a high anal or rectal internal opening were treated with a cutting seton. In the postoperative period none of the patients had recurrence or solid stool incontinence. However, three of them had just flatus incontinence, and two had flatus and liquid stool incontinence. The new material we used as a new type of seton can be used efficiently; it can be inserted easily, is cheap and effective, and may give better therapeutic results and better patient satisfaction.

The impact of oral feeding on the severity of acute pancreatitis

BACKGROUND In the management of acute pancreatitis, oral feeding is prohibited and either enteral or parenteral feeding is commenced for the patients in an effort to not increase the secretion of the pancreatic enzymes. PURPOSE This study was undertaken in an attempt to determine the impact of oral feeding on the severity of acute pancreatitis and to compare this impact with that of parenteral feeding. MATERIALS AND METHODS Twenty-four female Sprague-Dawley rats were divided into two groups. In both groups, acute pancreatitis was induced by ligation of the main biliopancreatic duct. The rats in group I were fed orally and the rats in group II were fed parenterally. The rats were sacrificed at 48 hours, and blood samples were obtained from the heart upon exposure of the abdominal and thoracic cavities. The pancreas and the left lung were removed for histopathological examination. The levels of lactic dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), glucose, calcium and blood urea nitrogen, base deficit, partial oxygen pressure, leukocyte count, and hematocrit level among Ranson criteria and the level of amylase were measured. The pancreas and the lung were examined under a light microscope. RESULTS The levels of LDH, SGOT, and calcium for the rats in group I were significantly higher when compared with the rats in group II (P <0.05). Similarly, the levels of amylase for the rats in group I were found to be higher when compared with the rats in group II, but the difference was not significant. Inflammatory changes observed in the pancreas were less severe whereas inflammatory changes observed in the lung were more severe for the rats in group I when compared with the rats in group II. CONCLUSION The blood levels of the enzymes were adversely affected for the rats fed orally. In contrast, inflammatory changes observed in the pancreas were more severe for the rats fed parenterally. The study suggests that certain hormones released from the duodenum upon stimulation by oral nutrient intake lessens the severity of pancreatitis through protective effects on the pancreas, whereas the elevated levels of the enzymes cause endothelial damage resulting in destruction in distant organs such as the lung.

Long-term results utilizing the unroofing technique in treating hydatid cysts of the liver

PurposeThe aim of this study was to present the long-term follow-up results of liver hydatid cysts treated with unroofing, together with a review of the related literature data.MethodsOf 700 liver hydatid cyst patients examined and treated at Selcuk University Meram Medical Faculty, General Surgery Department, between 1985 and 2007, 650 had accessible data and the unroofing method had been applied in 189 of them. The clinical and laboratory findings, stages, operations, and complications of patients treated with unroofing were reviewed. In particular, the resolution of residual cyst cavities over time after the application of this method was evaluated using computed tomography.ResultsFour hundred and thirty-six (67.07%) of the cases were female [mean age: 35 (range: 10–73) years] and 214 (32.9%) were male [mean age: 46 (range: 12–76) years]. Of the 189 cases treated with unroofing and followed by tomography, the data of 144 were documented. Cavities were classified into five groups (A-E) according to their postoperative appearance.ConclusionsUnroofing is an easy approach and it does not require extensive experience. This technique is recommended for peripherally localized cysts but may also be applied to those more deeply situated. Unroofing should be applied as deeply as possible and the residual cavity should also be as shallow as possible.

Effect of Octreotide (Sandostatin 201-995) on Bile Flow and Bile Components

Octreotide (Sandostatin 201-995) has aninhibitory effect on gastric, intestinal, and pancreaticsecretions and hepatic and splachnic blood flow. Weexamined the effects of octreotide on bile flow and bile components in 10 patients with T-tubecholedochostomy. A Fogarty balloon catheter was inserteddistal to the T-tube of these patients for measurementof bile flow and bile components. Bile samples were obtained to analyze bile acid, phospholipid,lipoprotein, and cholesterol, and bile flow measurementswere performed every 15 min for a period of 90 minbefore study and after normal saline and octreotide administrations. While octreotide had aninhibitory effect on bile flow, the concentrations ofbile acid, phospholipid, and lipoprotein in bile wereincreased with octreotide.

Internal Herniation as a Major Cause of Intestinal Obstruction

Objectives: To evaluate internal herniation as a rare cause of intestinal obstruction.Materials and Methods: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42–67) and 2 were female (mean age: 56.5 years; range: 52–61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. Results: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. Conclusion: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary.

A comparison of the hemodynamic and metabolic effects of extraperitoneal carbon dioxide and nitrous oxide insufflation

BACKGROUND The aim of the present study was to compare the hemodynamic and metabolic effects of extraperitoneal carbon dioxide (CO(2)) and nitrous oxide (N(2)O) insufflation. MATERIAL AND METHODS Fourteen dogs were used in the experiment. All the animals were intubated under general anesthesia. A catheter was placed into the right jugular vein for central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and heart rate (HR) monitorization. End-tidal CO(2) pressure was measured by a capnometer connected to the endotracheal tube. Another catheter was inserted into the left femoral artery for arterial blood gas analysis and blood pressure monitorization. The preperitoneal dissection was made from a 1.5 cm subumbilical incision by using a preperitoneal dissection balloon. A laparoscope was placed in the preperitoneal space and the gas insufflation was kept at a constant pressure of 12 mm Hg throughout the experiment. All the study parameters were measured at the beginning of the insufflation and at every 15 minutes for 1 hour. RESULTS Mean artery pressure increased with time in both groups, but the increase was only significant in the CO(2) group. PWP, CVP, PAP, and HR increased slightly in both groups, but there was no significant difference between the groups. The end-tidal CO(2) increased in the CO(2) group but decreased from the baseline in the N(2)O group. A significant acidosis was observed in only the CO(2) group. PaCO(2) significantly increased in the CO(2) group; hence, PaCO(2) slightly decreased in N(2)O group. The difference between the groups was significant. CONCLUSIONS N(2)O insufflation of the extraperitoneal space in dogs avoided the unwanted metabolic and hemodynamic side effects of CO(2) insufflation. Thus, N(2)O insufflation in the extraperitoneal space is a safer alternative to CO(2) insufflation experimentally, and can be preferred especially in patients with cardiac and pulmonary diseases.

Solitary juxtacortical neurofibroma of the humerus

Abstract. A neurofibroma as a discrete, superficial tumor of a long bone has been described only once in the world literature. We report the radiologic findings of a case of a juxtacortical neurofibroma.

Pilonidal sinüs ameliyatlarındaki artış normal mi

GIRIŞ Pilonidal sinus, gobek basta olmak uzere degisik yerlesimlerde gorulmekle birlikte en sik yerlesim yeri sakrokoksigiyal bolgedir. Daha cok 15–30 yas arasindaki aktif genclerde ve erkeklerde gorulur. Hastaligin etyopatogenezi ve tedavisi en cok tartisilan konulardir. Gunumuzde pilonidal sinusun edinsel hastalik oldugu genel kabul gormektedir. Akdeniz ulkelerinde yuksek siklik gosterir (2). Turk askerleri arasinda %8,8 oraninda pilonidal sinus bulunmustur (3). Insan sagligi ve ulkemizde cok uzerinde durulmayan ekonomik yuk ve isgucu kaybi bakimindan %8,8 onemli bir orandir.