Feyzullah Ersoz

Abdominal Wall Endometrioma; A 10-Year Experience and Brief Review of the Literature

BACKGROUND Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. METHODS Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. RESULTS There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. CONCLUSIONS Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

Determinants of postoperative hypocalcemia in vitamin D–deficient Graves’ patients after total thyroidectomy

BACKGROUND The etiology of postoperative hypocalcemia after total thyroidectomy appears to be multifactorial, that is, postoperative transient hypoparathyroidism, low 25-hydroxy vitamin D (25-OHD) concentrations, aging, and hyperthyroidism with increased bone turnover. Our aim was to evaluate the factors responsible for postoperative hypocalcemia in euthyroid vitamin D-deficient/insufficient Graves patients who underwent total thyroidectomy at our institution. METHODS Thirty-five consecutive patients with Graves disease treated by total thyroidectomy were included in the present study. All patients were vitamin D deficient/insufficient (ie, 25-OHD concentrations of <20/<30 ng/mL, respectively). Patients were divided into 2 groups according to postoperative serum albumin corrected calcium concentrations: group 1 (n = 13) patients had postoperative serum calcium concentrations of 8 mg/dL or less; group 2 (n = 22) patients had serum calcium concentrations greater than 8 mg/dL. Bone turnover markers (deoxypiridinoline, bone-specific alkaline phosphatase) and 25-OHD were determined the day before surgery. RESULTS In group 1 patients, disease duration was significantly longer, 25-OHD and postoperative parathyroid hormone concentrations were significantly lower, and bone turnover markers were significantly higher. Logistic regression analysis revealed that a postoperative parathyroid hormone concentration less than 10 pg/mL was the most powerful parameter to predict postoperative hypocalcemia (odds ratio, 23; 95% confidence interval, 3.3-156). CONCLUSIONS In Graves patients with vitamin D deficiency/insufficiency, postoperative (transient) hypoparathyroidism is the most significant parameter to determine the development of postoperative hypocalcemia.

A new approach to postoperative peritoneal adhesions: Prevention of peritoneal trauma by aloe vera gel

OBJECTIVE Covering peritoneal surfaces with aloe vera gel may prevent peritoneal trauma and hence postoperative peritoneal adhesions. STUDY DESIGN Forty Wistar albino out-bred female rats (mean weight, 180+/-25 g; mean age, 6 months) were divided into four groups. In Group 1, 0.1 mL aloe vera gel was injected into the peritoneal cavities. In Group 2, peritoneal adhesions were induced. In Group 3, adhesions were induced and the modeled area was covered by 0.1 mL aloe vera gel. In Group 4, the area was covered with aloe vera gel prior to adhesion induction. The rats were sacrificed on postoperative day 10 and the adhesions were scored both microscopically and macroscopically. RESULTS The mean macroscopic adhesion score in the four groups was 0, 5.8+/-0.42, 5.2+/-0.79, and 1.1+/-1.2 respectively, with the difference between Group 4 and Groups 2 (p<0.001) and 3 (p<0.05) statistically significant. The mean histopathological fibrosis values were significantly higher in Group 3 than in Group 4 (2.6+/-0.51 vs 1.2+/-0.91, p=0.002). CONCLUSION Aloe vera gel can effectively decrease adhesion formation if applied before, but not after, after peritoneal trauma. This effect is likely due not to its chemical properties but to its viscosity, providing a covering to prevent peritoneal trauma.

Effects of contractubex on the prevention of postoperative peritoneal adhesion.

BACKGROUND There are numerus techniques and agents in use for reducing peritoneal adhesion formation. But in this research we believe this is the first research to reveal that contractubex (allium cepae, sodium heparin, and allantoin mixture) is reducing formed peritoneal adhesions. So it may be used to reduce the number of re-laparotomies/re-laparoscopies caused by peritoneal adhesions related complications. OBJECTIVE To evaluate the effects of contractubex (CT) in a rat model of postoperative peritoneal adhesion (PPA). METHODS Fifty rats were divided into four equal groups. In group 1, 1 g of CT was injected into the peritoneal cavity. In group 2, adhesions were generated. In group 3, adhesions were generated, and 1 g of CT was immediately applied into the peritoneal cavity. In group 4, adhesions were generated, and at postoperative d 7, 1 g of CT was applied into the peritoneal cavity. In group 5, adhesions were generated, and at postoperative d1, 3, 5, and 7, 1 g of CT was applied into the peritoneal cavity. The adhesions were scored both macroscopically and microscopically. RESULTS The mean macroscopic adhesion scores in groups 1-5 were 0 ± 0, 2.9 ± 0.21, 2.3 ± 0.54, 0.8 ± 0.63, and 2.2 ± 0.72, respectively (P < 0.0001); the mean microscopic values were 0 ± 0, 2.8 ± 0.42, 2.8 ± 0.42, 0.6 ± 0.52, and 2.3 ± 0.48, respectively (P < 0.0001). The mean macroscopic adhesion score in group 4 was lower than that in group 2 (P = 0.001). The mean macroscopic adhesion scores in groups 3 and 5 were higher than those in group 4 (P = 0.045 and P = 0.038, respectively) but did not significantly differ from those in group 2 (P = 0.171 and P = 0.124, respectively). COMMENTARY A single dose of contractubex did not prevent PPA formation but did diminish the amount of formed PPAs.

Predictive Value of Thyroid Tissue Density in Determining the Patients on Whom Sternotomy Should be Performed

BACKGROUND Retrosternal goiter incidence rates range between 0.2% and 45% of all goiters, and sternotomy is performed in some of patients. There is no consensus for selecting the patients on whom sternotomy should be performed. We aimed to determine the most important factor for predicting requirement of sternotomy. METHODS This prospective study included 260 patients with retrosternal goiter. The clinical symptoms, history of previous thyroidectomy, presence of tracheal deviation, tracheal compression, site of mediastinal extension, thyroid tissue density, findings of intubation, type of surgical approach, histologic findings of thyroid, weight of thyroid, and postoperative complications were evaluated. RESULTS Thyroid tissue density, posterior location, and subcarinal extension were found to be independent factors for predicting requirement of sternotomy. The risk for sternotomy increased 47-fold for patients with harder thyroid tissue density (OR: 47.3; 95% CI: 5.8-385.70), 20-fold for patients with subcarinal extension (OR: 20.5; 95% CI: 2.5-168), and 10-fold for patients with posterior location (OR: 10.5; 95% CI:1.8-60). CONCLUSION Thyroid tissue density was defined the strongest predictive factor for requirement of sternotomy. Preoperatively obtained information thyroid tissue density can be useful for surgical strategy.

DOES A FITTED ABDOMINAL CORSET MAKES COLONOSCOPY MORE TOLERABLE

Background and Aim:  The present study evaluated the usefulness of a fitted abdominal corset for colonoscopy, enabling proper compression of the abdomen during the entire examination.

Comparative outcomes of antireflux treatment for laryngopharyngeal reflux symptoms and upper abdominal symptoms in patients with endoscopic esophagitis

The objectives of this prospective study are to determine the prevalence of laryngopharyngeal reflux (LPR) symptoms in patients with endoscopic esophagitis, to investigate the relationship between LPR symptoms and upper abdominal symptoms of gastroesophageal reflux disease (GERD) and to compare the treatment responses of both symptom groups. 120 consecutive patients having complaints of GERD were included. Group I consisted of 62 patients with a diagnosis of endoscopic esophagitis. The second group consisted of 58 subjects with no detectable pathology at gastroscopy. LPR symptoms and upper abdominal symptoms were graded. Proton pump inhibitors (PPI) were prescribed to patients. Both groups of symptoms were compared in two groups of patients. The improvement in symptoms was evaluated after treatment. The frequencies of LPR symptoms were statistically higher in patients with endoscopic esophagitis. All LPR symptoms were statistically relieved in their frequency after treatment. The decrease in LPR symptom scores after treatment in group I was statistically significant. FSSG (frequency scale for the symptoms of GERD) scores were statistically higher in group I than in group II before treatment. After treatment, FSSG scores were significantly decreased in group I. There was statistically significant positive correlation between the LPR symptom scores and FSSG scores before treatment. In conclusion, there is a high incidence of LPR symptoms and upper abdominal symptoms in patients with endoscopic esophagitis. LPR and upper abdominal symptoms responded well to antireflux treatment in patients with endoscopic esophagitis.

New and Simple Approach for Preventing Postoperative Peritoneal Adhesions: Do not Touch the Peritoneum without Viscous Liquid—A Multivariate Analysis

Background. Postoperative peritoneal adhesions (PPAs) are an unsolved and serious problem in abdominal surgery. Method. Viscous liquids of soybean oil, octyl methoxycinnamate, flax oil, aloe vera gel, and glycerol were used in five experiments, using the same methodology for each. Liquids were applied in the peritoneal cavity before and after mechanical peritoneal trauma. Results were evaluated by multivariate analysis. Results. Compared with the control group, macroscopic and microscopic adhesion values before (P < .001) and after (P < .05) application of viscous liquids significantly reduced PPAs. Values were significantly lower when liquids were applied before rather than after peritoneal trauma (P < .0001). Discussion. Viscous liquids injected into the peritoneal cavity before or after mechanical peritoneal trauma decrease PPA. Injection before trauma was more effective than after trauma. In surgical practice, PPA formation may be prevented or decreased by covering the peritoneal cavity with an appropriate viscous liquid before abdominal surgery.

Radio-guided excision of parathyroid lesions in patients who had previous neck surgeries: A safe and easy technique for re-operative parathyroid surgery

BACKGROUND Several methods have been recommended to detect parathyroid lesions in patients who have previously undergone neck surgeries, including radio-guided surgery or intraoperative ultrasounds. In this study, we aimed to investigate whether the radio-guided excision of pathologic parathyroid lesions allowed us to find affected lesions in patients who had previously undergone neck operations. METHODS This prospective study included 18 patients with primary hyperparathyroidism who had previously undergone neck surgeries. The pathologic parathyroid lesions were localized by ultrasonography, and a radiotracer was injected directly into the lesions. RESULTS Careful dissections were carried out by following the area of maximum radioactivity until the lesions were identified and excised. Eighteen parathyroid adenomas were removed in 18 patients. The median count from each lesion was significantly higher than the values measured from the adjacent tissues and the lesion beds (12550/20 s, 370/20 s, and 35/20 s, respectively; p < 0.001). CONCLUSION Radio-guided excision of parathyroid lesions can be performed safely for re-operative parathyroid surgery.

MALT lymphoma of the rectum, presenting with rectal prolapsus: a case report.

Up to now, there have been only a few reported cases of Mucosa-associated lymphoid tissue (MALT) lymphomas arising in the rectum. Its clinical presentation is indistinguishable from that of rectal carcinoma but the treatment is apparently different. Symptoms of primary lymphomas involving the rectum include; anorexia, weight loss, change in bowel habits, obstruction, and bleeding. These symptoms are not disease specific and can be seen in many other gastrointestinal disorders. Patients with polypoid masses may present with obstruction symptoms. In this rare case, a female patient admitted to the emergency service with prolapsus of a rectal mass.The optimal treatment of rectal MALT lymphoma is not well defined yet, given the rarity of the disease. Surgical resection of the localized lesion and following adjuvant chemotherapy has proved to be an effective treatment option. However, a close and long-lasting follow-up is important.