Hande Köksal

Total oxidant status, total antioxidant status, and paraoxonase and arylesterase activities during laparoscopic cholecystectomy

INTRODUCTION: Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease; however, adverse hemodynamic changes induced by increased intraabdominal pressure due to pneumoperitoneum are known to occur. Herein, we investigated the effects of pneumoperitoneum on oxidative stress markers, including paraoxonase, arylesterase, total oxidant status, and total antioxidant status, during laparoscopic cholecystectomy. PATIENTS AND METHODS: Patients that underwent a laparoscopic cholecystectomy were classified as Group I, whereas patients that underwent surgical procedures for an abdominal wall hernia under general anesthesia were classified as Group II. Blood samples were obtained during the preoperative period, the perioperative period, and 24 hours after surgery (postoperative day 1). Leukocyte counts, neutrophil rates, paraoxonase activities, arylesterase activities, and total oxidant and antioxidant status levels were measured. RESULTS: The differences in leukocyte counts and neutrophil rates were not significant between the two groups. In Group I, no significant differences in the total oxidant and antioxidant status levels were identified; however, paraoxonase and arylesterase levels were lower on postoperative day 1. No significant changes were observed in the total oxidant status, total antioxidant status, and paraoxonase or arylesterase activities in Group II. The perioperative total antioxidant status and arylesterase level were higher in Group I in comparison to Group II. CONCLUSION: Paraoxonase and arylesterase levels are useful markers in the evaluation of oxidative stress caused by intraabdominal pressure due to pneumoperitoneum.

Total oxidant status, total antioxidant status, and paraoxonase activity in acute appendicitis

BACKGROUNDnThe aim of this study was to investigate the levels of oxidative stress including total oxidant status, total antioxidant status, and paraoxonase activity in patients with a diagnosis of acute appendicitis.nnnMETHODSnSeventy-three patients who underwent surgery with a preoperative diagnosis of acute appendicitis (Group I) were included into the study. The control group (Group II) consisted of thirty otherwise healthy subjects. After histopathologic examination, the patients were categorized as follows: 1) Acute focal appendicitis, 2) Acute advanced appendicitis including acute suppurative, phlegmonous and gangrenous appendicitis, 3) Acute perforated appendicitis, 4) Sub-acute appendicitis, and 5) Negative exploration. Blood samples for paraoxonase activities, and total oxidant and antioxidant status levels were obtained preoperatively.nnnRESULTSnTotal oxidant and antioxidant status of the patients in the acute appendicitis group were higher than those of the control group. When paraoxonase activities of Group I was compared with Group II, no significant difference was determined. Both total oxidant and antioxidant status levels of acute perforated appendicitis were higher than those of both acute focal appendicitis and acute advanced appendicitis.nnnCONCLUSIONnThe increase in the oxidative status (total oxidant and antioxidant status) was related with the progression of inflammation to the perforation in acute appendicitis.

Laparoskopik kolesistektomi süresince splanknik sahadaki hemodinamik değişikliklerin değerlendirilmesinde iskemi modifiye albuminin rolü

GIRIŞ Laparoskopi, karin ici hastaliklarinin tani ve tedavisinde sik kullanilan minimal invaziv bir yontemdir. Klinik olarak oldukca faydasi olmasina ragmen, pnomoperitoneuma bagli bir takim yan etkiler gozlenebilir. Pnomoperitoneum olusturmak icin, cok cabuk absorbe olan karbondioksit gazi kullanilmaktadir. Pnomoperitoneuma bagli yukselen karin ici basinc, karin ici organlarin kan akimina etki yapmaktadir (1-8).

Bilateral Breast Necrosis Due to Local Injection of Fish Oil

The breast is as aesthetically important as it is physiologically. Physicians and women have practiced various methods for breast aesthetics and augmentation. We report a female veterinarian who injected fish oil into her breast, which led to inflammation and necrosis of breast tissue. When all medical therapies failed, bilateral subcutaneous mastectomy was performed. We did not find a case in the literature where fish oil had been used for breast augmentation. However, we did find that many agents have been injected for breast augmentation, the results of which were tragic, just as the case presented herein.

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.

Cleft nipple: A rare congenital breast anomaly

A 19-year-old lady presented for an abnormal image of her left nipple. On physical examination, there were no pathology on breasts and axillary regions except left nipple disfiguration. She had no history of breast feeding, trauma or breast surgery, also she had no family history of this kind. Breast ultrasound was completely normal including breast parenchyma, lactifery ducts, pectoral muscles and axillary region. Although she had no symptom; when the literature knowledge about congenital breast anomalies taken into account; urinary system ultrasound and breast MRI were also performed for the detection of urinary congenital anomalies and pectoral muscle congenital anomalies if there exists. Both of the imaging studies were normal (Figure 1). According to her claim for aesthetic correction, two Z-plasties in opposite orientations were performed just as described in the literature by Shah et al (Figure 2). Congenital breast deformities and nipple anomalies cause significant psychological distress in women and it is unsurprising that the majority of women request surgical correction. Cleft nipple is a congenital anomaly apart from intra-areolar plythelia

Prective value of preoperative neutrophil-to-lymphocyte ratio in detecting bowel resection in hernia with intestinal incarceration

Background The aim of this study was to evaluate the relationship between preoperative hematological inflammatory markers of the patients who underwent a surgery for incarcerated hernia and intestinal resection requirement. Methods The data of 102 patients who underwent a surgery for incarcerated hernia were retrospectively evaluated. Whole blood cell counts were preoperatively measured, and operation types and pathology results were recorded. The patients with intestinal resections were compared with those without any resection in terms of leukocyte number, neutrophil rate, red cell distribution width (RDW), platelet distribution width, neutrophil-to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV). Results Eighty-one patients were operated for incarcerated groin hernia, 17 for incarcerated umbilical hernia, and 4 for incarcerated incisional hernia. Twenty-six patients (25%) had intestinal resections; in 4 of them, intestinal perforation was detected. In patients with intestinal resections,the neutrophil rate, PDW, NLR, and PLR values were significantly higher than those in the patients without any resections. Conclusion High NLR rates, certainly with clinical correlation, can be used as a biomarker to predict intestinal necrosis and the need for intestinal resection in patients who will undergo surgery for incarcerated hernia, particularlyin situations with lacking radiological imaging methods.BACKGROUNDnThe aim of this study was to evaluate the relationship between preoperative hematological inflammatory markers of the patients who underwent a surgery for incarcerated hernia and intestinal resection requirement.nnnMETHODSnThe data of 102 patients who underwent a surgery for incarcerated hernia were retrospectively evaluated. Whole blood cell counts were preoperatively measured, and operation types and pathology results were recorded. The patients with intestinal resections were compared with those without any resection in terms of leukocyte number, neutrophil rate, red cell distribution width (RDW), platelet distribution width, neutrophil-to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV).nnnRESULTSnEighty-one patients were operated for incarcerated groin hernia, 17 for incarcerated umbilical hernia, and 4 for incarcerated incisional hernia. Twenty-six patients (25%) had intestinal resections; in 4 of them, intestinal perforation was detected. In patients with intestinal resections,the neutrophil rate, PDW, NLR, and PLR values were significantly higher than those in the patients without any resections.nnnCONCLUSIONnHigh NLR rates, certainly with clinical correlation, can be used as a biomarker to predict intestinal necrosis and the need for intestinal resection in patients who will undergo surgery for incarcerated hernia, particularlyin situations with lacking radiological imaging methods.

Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study

OBJECTIVEnAlthough the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey.nnnMATERIAL AND METHODSnThe relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically.nnnRESULTSnThe study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Başkent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%).nnnCONCLUSIONnThe findings of the study indicate a steady increase in surgical admissions to emergency units. Non-traumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

Is total-subtotal colectomy and primary anastomosis a good treatment alternative in malignant obstructive lesions of the left colon?

BACKGROUNDnThis study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon.nnnMETHODSnPatients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively.nnnRESULTSnThe mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups.nnnCONCLUSIONnWe suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures.