Göktürk Maralcan

The use of fibrin glue in the treatment of fistula-in-ano: a prospective study.

PurposeThis prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano.MethodsThis clinical trial of 36 patients was performed during the period from November 2003 to May 2004. Thirty men and six women were treated for a fistula-in-ano with commercial fibrin glue application. None of the patients had undergone prior attempts to correct fistulas-in-ano surgically. All patients received preoperative mechanical bowel preparation and prophylactic intravenous antibiotics. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until fibrin glue could be seen coming from the internal opening. No dressing was applied over the external opening. Thereafter, the patient was discharged. A 1-week course of oral antibiotics was prescribed. The patients were followed up for 70 weeks with a mean of 54 weeks (range 40–70 weeks).ResultsThe cause of the fistula-in-ano was cryptoglandular in all patients. The overall initial success rate was 77.8% (28/36). No complications were encountered related to the application. Two patients underwent a reapplication with fibrin glue and the fistulas of these patients were all closed. The overall success rate was 83.3% (30/36).ConclusionFibrin glue application was thus found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano. However, our findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.

The Efficacy of Ankaferd Blood Stopper for the Management of Bleeding Following Total Thyroidectomy

ABSTRACT Purpose: Postoperative hematoma remains an uncommon but potentially life-threaten complication of thyroid surgery. The aim of this study is to assess the efficacy of Ankaferd Blood Stopper (ABS) in comparison to hemostasis by conventional technique (HCT) for the controlling of oozing-type bleeding following total thyroidectomy. Methods: We randomized 61 patients with benign euthyroid multinodular goiter who underwent total thyroidectomy subject to one of the two different hemostasis techniques. There were 31 patients in the HCT group and 30 patients in the ABS group. The study was designed prospectively to compare ABS and HCT groups in terms of operation time, postoperative drainage, duration of postoperative stay, and complications. Results: Mean postoperative drainage from the closed suction drains at first 24 hr were 24.6 ± 8.6 ml and 12.0 ± 9.2 ml (p = .001) and mean total postoperative drainage were 38.5 ± 13.2 ml and 20.6 ± 12.2 ml (p = .001) in the HCT and ABS groups, respectively, indicating statistically significant differences. Conclusions: On the basis of the results of this trial, the use of ABS seems to be more effective than HCT to control hemorrhage following total thyroidectomy.

Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study

Purpose This prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano from a long-term (mean 4.5 years) research period. Methods This clinical trial of forty-six patients was performed during the period from January 2004 to February 2005. Thirty-nine men and seven women were treated for a fistula-in-ano with a commercial fibrin glue application. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until the fibrin glue could be seen coming from the internal opening. Results The overall initial success rate was 86.95% (40/46). Recurrence rate was 41.30% (19/46). Two patients underwent a re-application with fibrin glue and the fistulas of these patients closed. The total recurrence rate was 36.95% (17/46). The long-term overall success rate was 63.04% (29/46). Conclusion Fibrin glue application was thus found to be an easy, safe, acceptable, successful alternative treatment in the management of fistulas-in-ano. Choosing the patient correctly is very important because long (more than 4 cm) and non-ramificate fistula tracts usually close with commercial fibrin glue.

A Cyclin D1 (CCND1) Gene Polymorphism Contributes to Susceptibility to Papillary Thyroid Cancer in the Turkish Population

Cyclin D1 is an important positive regulator of the G1/S phase of the cell cycle. We investigated the association between the CCND1 G870A polymorphism and susceptibility to papillary thyroid cancer in Turkish people. This study covered 102 patients with papillary thyroid cancer and 174 healthy controls. CCND1 genotyping was determined by the PCR-RFLP method. We found that the A allele frequency was higher in the cases than in the controls (p=0.042). On stratification analysis, papillary thyroid cancer risk was significantly elevated in individuals older than 45 years with the A allele (OR=1.91, 95% CI, 1.09-3.35, p=0.024) and in females with the A allele (OR=1.73, 95% CI, 1.06-2.84, p=0.029), compared to the G allele. According to the subject age, there was an increased papillary thyroid cancer risk for the individuals older than 45 years with the AA genotype (OR=2.28, 95% CI, 1.02-5.13, p=0.046) compared to the AG+GG combined genotypes. In conclusion, it is suggested that the CCND1 G870A polymorphism may contribute to the susceptibility to papillary thyroid cancer, especially in those who were older subjects (45 ≤ years old) and female, in the Turkish population.

Biochemical and histopathological changes of intra-abdominal hypertension on the kidneys: Experimental study in rats

OBJECTIVE This study aimed to evaluate the effects of experimentally induced intra-abdominal hypertension on renal functions, with the combination of biochemical and histopathological properties. MATERIAL AND METHODS Thirty male Wistar albino rats were used in this experimental study. Rats were divided into four groups. Group 1 (control group, n=6) only received anesthesia. After the induction of anesthesia, a 20 G catheter was introduced intraperitoneally to Group 2 (sham group, n=8), Group 3 (n=8) and Group 4 (n=8). The intra-abdominal pressure was not increased in Group 2. We applied 20 mmHg intra-peritoneal pressure to Group 3 and 30 mmHg to Group 4 for 3 hours. After withdrawing 3 mL intracardiac blood from all groups, the kidneys were removed for histopathological examination. Serum urea and creatinine levels were measured in all groups. RESULTS Biochemical examination showed that blood urea and creatinine levels were statistically different among all groups (p<0.05). Serum creatinine levels in Group 3 and serum urea and creatinine levels in Group 4 were significantly increased. In the histopathological examination, the kidneys in Group 1 and Group 2 were classified as normal. In Group 3, areas with congestion were detected in the glomeruli and interstitial regions. In addition to these findings seen in Group 3, dilatation of the pelvi-caliceal structures and proximal ureters were noticed in Group 4. CONCLUSION The levels of serum urea and creatinine are elevated when intra-abdominal pressure is increased due to kidney damage. Foci of hemorrhage in the interstitial area, dilatations in the proximal ureter, renal pelvis, and lymphatics were the pathologic findings seen in the kidneys under such circumstances.

Comparison of 4% icodextrin and auto-crosslinked hyaluronic acid gel in terms of efficacy and cost effectivity in preventing postoperative abdominal adhesions

This experimental study was designed to compare the effects and costs of 4% icodextrin and hyaluronic acid in intraabdominal adhesion formation in rats. This study included 30 healthy Wistar albino rats, each weighing 250-300 gr. Following cecal-ileal abrasion to rats in each group, the following treatments were applied: Group 1 (control, n:10) 5 ml saline irrigation; Group 2 (n:10) 5 ml 4% icodextrin solution; Group 3 (n:10) 3 ml auto-crosslinked hyaluronic acid gel. After 14 days, following a second operation, adhesion intensity scoring, histopathological assessment (inflammation, fibrosis) and costs were compared between groups. The lowest postoperative adhesion intensity score was found in the group 3 and the highest score was found in the group 1 (p=0.028). Group 3 had a non-significantly lower adhesion intensity score than group 2 (p>0.05). In terms of inflammation and fibrosis, group 2 had the lowest score, but there were no significant differences between all the groups (p>0.05). In terms of cost, 4% icodextrin is less expensive than hyaluronic acid. The results demonstrated that both hyaluronic acid and 4% icodextrin are similarly effective in reducing postoperative intraabdominal adhesions. In addition, 4% icodextrin is more cost-effective, which can be an advantage for clinical studies.