Hüseyin Yüce Bircan

Laparoscopic Treatment of Gallstone Ileus

Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.

Effect of Topical Platelet-Rich Plasma on Burn Healing After Partial-Thickness Burn Injury.

Background To investigate the effects of platelet-rich plasma on tissue maturation and burn healing in an experimental partial-thickness burn injury model. Material/Methods Thirty Wistar albino rats were divided into 3 groups of 10 rats each. Group 1 (platelet-rich plasma group) was exposed to burn injury and topical platelet-rich plasma was applied. Group 2 (control group) was exposed to burn injury only. Group 3 (blood donor group) was used as blood donors for platelet-rich plasma. The rats were killed on the seventh day after burn injury. Tissue hydroxyproline levels were measured and histopathologic changes were examined. Results Hydroxyproline levels were significantly higher in the platelet-rich plasma group than in the control group (P=.03). Histopathologically, there was significantly less inflammatory cell infiltration (P=.005) and there were no statistically significant differences between groups in fibroblast development, collagen production, vessel proliferations, or epithelization. Conclusions Platelet-rich plasma seems to partially improve burn healing in this experimental burn injury model. As an initial conclusion, it appears that platelet-rich plasma can be used in humans, although further studies should be performed with this type of treatment.

Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.

Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique.

The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter‐related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter‐related complications and follow‐up data. Sixty‐nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long‐term survivals. All of the CAPD‐related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.

Complications following endoscopic retrograde cholangiopancreatography: minimal invasive surgical recommendations.

Background ERCP has a complication rate ranging between 4% and 16% such as post-ERCP pancreatitis, hemorrhage, cholangitis and perforation. Perforation rate was reported as 0.08% to 1% and mortality rate up to 1.5%. Besides, injury related death rate is 16% to 18%. In this study we aimed to present a retrospective review of our experience with post ERCP-related perforations, reveal the type of injuries and management recommendations with the minimally invasive approaches. Methods Medical records of 28 patients treated for ERCP-related perforations in Okmeydani Training and Research Hospital between March 2007 and March 2013 were reviewed retrospectively. Patient age, gender, comorbidities, ERCP indication, ERCP findings and details were analyzed. All previous and current clinical history, laboratory and radiological findings were used to assess the evaluation of perforations. Results Between March 2007 and March 2013, 2972 ERCPs were performed, 28 (0.94%) of which resulted in ERCP-related perforations. 10 of them were men (35.8%) and 18 women (64.2%). Mean age was 53.36±14.12 years with a range of 28 to 78 years. 14 (50%) patients were managed conservatively, while 14 (50%) were managed surgically. In 6 patients, laparoscopic exploration was performed due to the failure of non-surgical management. In 6 of the patients that ERCP-related perforation was suspected during or within 2 hours after ERCP, underwent to surgery primarily. There were two mortalities. The mean length of hospitalization stay was 10.46±2.83 days. The overall mortality rate was 7.1%. Conclusion Successful management of ERCP-related perforation requires immediate diagnosis and early decision to decide whether to manage conservatively or surgically. Although traditionally conventional surgical approaches have been suggested for the treatment of perforations, laparoscopic techniques may be used in well-chosen cases especially in type II, III and IV perforations.

Evaluation of Transplanted Kidneys and Comparison with Healthy Volunteers and Kidney Donors with Diffusion-Weighted Magnetic Resonance Imaging: Initial Experience.

OBJECTIVES The aim of this study was to evaluate the feasibility of diffusion-weighted magnetic resonance, by comparing imaging in renal allograft recipients for functional assessment of kidney transplants versus imaging of these features in healthy volunteers and kidney donors with native kidneys. MATERIALS AND METHODS Seventy renal transplant recipients (group A) with stable graft function at postoperative month 1, 40 healthy volunteers (group B), and 40 kidney donors (group C) underwent diffusion-weighted magnetic resonance imaging. An echo-planar diffusion-weighted imaging sequence was performed in coronal orientation by using 6 b values (0, 200, 400, 600, 800, 1000 s/mm²). The apparent diffusion coefficients were determined for the upper and lower poles of the kidney cortex and medulla. Relations between apparent diffusion coefficients and allograft function, determined by the estimated glomerular filtration rate (comparing rates > 60 mL/min/1.73 m² [group A1] versus < 60 mL/min/1.73 m² [group A2]), were investigated in renal transplant recipients, and apparent diffusion coefficients in groups A, B, and C were compared. RESULTS Apparent diffusion coefficients were statistically higher in group A1 than in group A2 (P < .05) and statistically higher in group A than in groups B and C (P < .001). There were no significant differences between groups B and C (P > .05). CONCLUSIONS We observed that apparent diffusion coefficients of transplanted kidneys at postoperative month 1 were higher than values in native kidneys of healthy volunteers and kidney donors. In addition, apparent diffusion coefficients of transplanted kidneys with estimated glomerular filtration rates > 60 mL/min/1.73 m² were higher than transplanted kidneys with rates < 60 mL/min/1.73 m².

The effects of aging on lymphocyte subgroups in males and females

Background Age-associated immune senescence is a catch-all phrase that has been used to describe a plethora of changes to the immune system across the lifespan. Aging is associated with a decline in immune function. Our aim in this study was to investigate how lymphocyte subgroups in peripheral blood are affected by aging among males and females. Material/Methods Study participants were 70 healthy individuals from 3 different age groups, observed from January 2010 to January 2012. The average levels of CD3+, CD4+, CD8+, CD19+, CD16+/CD56+, CD3+/CD69+, and CD19+/CD69+ were determined for each group and compared in terms of age and sex. Results We found significant reduction in the level of CD3+T cells related with age, but no significant changes in CD19+ B cell levels (p<0.005). Aging significantly reduces activated B cell (CD19+/CD69+) levels in males (p<0.005). Conclusions Our results show that there may be differences between males and females in terms of immune senescence.

Cutaneous Necrosis As a Result of Isosulphane Blue Injection in Mammarian Sentinel Lymph Node Mapping: Report of Two Cases

Skin-sparing mastectomy with sentinel lymph node biopsy (SLNB) and synchronous breast reconstruction are widely used in breast cancer surgery nowadays. Difficulties in feeling confident in this technique and postoperative surgical complications are the major obstacles against the widespread usage of this technique. Compared with the other surgical techniques, the complications are hard to treat. Cutaneous necrosis because of methylene blue used for sentinel lymph node mapping in patients who underwent skin-sparing mastectomy and SLNB is already reported in the literature. We present here two cases with cutaneous necrosis because of isosulphane blue injection after skin-sparing mastectomy and SLNB as a rare complication of dye injection.

Thrombocytosis and small bowel perforation: unusual presentation of abdominopelvic actinomycosis.

Intrauterine devices (IUD) are frequently used as a family planning procedure in developing countries because they are easy to administer and governmental policies support their use in many countries. It is recommended that IUDs be removed or replaced after 10 years, but longer use is common, especially in developing countries. In some cases, rare infections such as pelvic inflammatory diseases, pelvic tuberculosis, or abdominopelvic actinomycosis related to IUD can develop. Pelvic actinomycosis is a rare disease and is often diagnosed incidentally during surgery. In recent years, there has been an increase in actinomycotic infections mostly due to long-term usage of IUD and forgotten intravaginal pessaries. It usually develops as an ascending infection. It is usually associated with non-specific symptoms such as lower abdominal pain, menstrual disturbances, fever, and vaginal discharge. The disease is sometimes asymptomatic. The rate of accurate preoperative diagnosis for pelvic actinomycosis is less than 10%, and symptoms and imaging studies sometimes mimic pelvic malignancy. This report details a case with abdominopelvic actinomycosis associated with an IUD presenting with highly elevated thromboctye count and small bowel perforation with abscess formation.

Influence of Various Living Donor Kidney Measurements in Relation to Recipient Body Measurements on Posttransplant Allograft Functional Outcomes.

OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipients body weight and body mass index on kidney function at 6 and 12 months after transplant. MATERIAL AND METHODS We included 74 patients (40 female and 34 male patients, mean age of 50.42 ± 9.75 y) in this study. RESULTS Intraoperative allograft weight was 182.68 ± 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 ± 24.26 mL (range, 78-181 mL). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively with allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index values, as concluded by univariate analyses. From multivariate analyses, we found variables of interest presumed to significantly affect the 12-month estimated glomerular filtration rates, including recipient age, allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index. CONCLUSIONS Transplanted allograft and recipient body values may be used as predictors of estimated glomerular filtration rates 6 and 12 months after transplant.