Ibrahim Yetim

Effect of Gentamicin-absorbed Collagen in Wound Healing in Pilonidal Sinus Surgery: A Prospective Randomized Study

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

Effect of Local Gentamicin Application on Healing and Wound Infection in Patients with Modified Radical Mastectomy: a Prospective Randomized Study

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Postoperative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved postoperative outcomes in patients undergoing modified radical mastectomy.

Effects of β-glucan pretreatment on acetylsalicylic acid-induced gastric damage: An experimental study in rats.

BACKGROUND NSAIDs have been found to induce gastrointestinal tract damage. Recently, it has been suggested that this might be mediated by lipid peroxidation. OBJECTIVE The aim of this study was to assess the potential protective effects of β-glucan against acetylsalicylic acid (ASA-induced gastric damage by means of its antioxidant capacity in an experimental rat model. METHODS Thirty-two male Wistar albino rats (200-250 g) were randomized into 4 groups consisting of 8 rats each. The β-glucan group received 50 mg/kg β-glucan once a day for 10 days and 30 minutes before anesthesia. The ASA group received saline once a day for 10 days and 300 mg/kg (20 mg/mL) ASA as a single dose, 4 hours before anesthesia. The ASA+β-glucan group was administered 50 mg/kg β-glucan once a day for 10 days and 30 minutes before anesthesia. Additionally, 300 mg/kg (20 mg/mL) ASA was administered as a single dose, 4 hours before anesthesia. The control group received saline once a day for 10 days and 30 minutes before anesthesia. All medications were administered by intragastric gavage. The stomach from each rat was dissected and divided into 2 parts for histologic and biochemical analysis. Gastric tissue malondialdehyde (MDA), nitric oxide (NO) levels, catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activities were determined for oxidative parameter analysis. RESULTS The gastroprotective and antioxidant effects of β-glucan appeared to attenuate the ASA-induced gastric tissue damage. Compared with the control group, MDA and NO levels and CAT and GSH-Px activities were significantly increased in the stomachs of ASA-treated rats (MDA, 4.12 [0.44] to 13.41 [1.05] μmol/L; NO, 8.04 [7.25-9.10] vs 30.35 [22.34-37.95] μmol/g protein; CAT, 0.050 [0.004] to 0.083 [0.003] k/g protein; GSH-Px, 0.57 [0.42-0.66] to 1.55 [1.19-1.76] U/L; all, P < 0.001), whereas SOD activity was significantly decreased in the same group (291 [29] to 124 [6] U/mL; P < 0.001). In the ASA+β-glucan group, MDA and NO levels and CAT and GSH-Px activities were found to be significantly lower, while SOD activity was found to be significantly higher, in comparison with the ASA-treated group (all, P < 0.001). CONCLUSION β-Glucan appeared to attenuate the gastric damage caused by ASA in these rats.

Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.

Unusual cause of gastric outlet obstruction: giant gastric trichobezoar: a case report

BackgroundTrichobezoars are caused by hair ingestion. The usual presentation of a trichobezoar is with early satiety and malnutrition. Obstructive symptoms and manifestations of gastric outlet obstruction may occur. The diagnosis may be suspected in young females with malnutrition, who have a history of trichophagia.Case presentationWe report a case of 12-year-old female admitted to the emergency room for abdominal pain. On physical examination, she was cachectic and an epigastric mass was palpated. An exploratory laparotomy was conducted. A giant trichobezoar was palpated in the stomach and was removed through an anterior gastrostomy.ConclusionThere were no complications postoperatively and the patient was referred to a psychiatrist.

Rare cause of intestinal obstruction, Ascaris lumbricoides infestation: two case reports

Ascaris lumbricoides is common resident of intestine especially low socioeconomic areas in the world. Complication of Ascaris lumbricoides has been reported include obstruction of the small intestine, intestinal volvulus and intussusception. We report two children with severe sequelae of intestinal obstruction.

Gossypiboma causing mechanical intestinal obstruction: a case report.

Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.

Massive upper gastrointestinal bleeding due to giant splenic artery aneurysm with gastric fistula

We aimed to report a case of a giant splenic artery aneurysm (SAA) with gastric fistula with the review of the literature. A female patient with splenic artery aneurysm was admitted to our hospital with abdominal pain and massive upper gastrointestinal bleeding. Hemorrhagic shock occurred. Despite the resuscitation, the patient died. Splenic artery aneurysms are the most common visceral aneurysm occurring predominantly in females with a ratio of 4:1. Giant aneurysm with thrombosis of the splenic artery is an extremely rare clinical entity and its size rarely exceeds to 3 centimeters. Although they are usually asymptomatic, SAA are clinically important because of the possibility of life-threatening rupture. Interventions or surgical treatment is indicated for symptomatic and giant aneurysms. Early diagnosis and prompt intervention is necessary for success of treatment.

Surgical outcomes of a civil war in a neighbouring country

Objectives The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. Methods 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. Results The median age of the patients was 30.05 (18–66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). Conclusions In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Shouldice Herniorrhaphy Technique: Surgeons Need to Remember It

DOI: 10.4328/JCAM.401 Received: 17.09.2010 Accepted: 26.10.2010 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):1-3 Corresponding Author: İbrahim Yetim, Mustafa Kemal Üniversitesi Tayfur Ata Sökmen Tıp Fakültesi Genel Cerrahi A.B.D Serinyol-Hatay ,Turkey. T.:+90 326 2111900 +90 532 5060009 E-mail:yetim54@gmail.com Özet Amaç: Genel cerrahların; acil dışındaki ameliyatlar arasında, en fazla yaptıkları ikinci sırada yer alan ameliyat fıtık onarımıdır. Shouldice herniorafi klasik ameliyatlardan biri olup gerilimli olarak adlandırılan ameliyat sınıfında yer almaktadır. Bu ameliyat her cerrahın repertuarında bulunmalıdır. Cerraha bir alternatif sağladığı gibi, gerilimsiz tekniklerin uygulanamayacağı vakalarda kullanımı zorunlu hale gelebilir. Bu çalışmada Lichtenstein herniorafi ve Shouldice herniorafi arasındaki avantaj ,dezavantaj ve komplikasyonlarını literatür eşliğinde inceledik. Gereç ve Yöntem: Hastanemizde yapılan Lichtenstein herniorafi ve seçilmiş hastalardaki Shouldice herniorafi vakalarını karşılaştırdık. Nisan 2007-mayıs 2008 tarihleri arasında inguinal herni tanısıyla Samsun Bafra Devlet Hastanesi Genel Cerrahi Servisi’nde Lichtenstein herniorafi yapılan 75 hasta ile Shouldice herniorafi yapılan 33 hasta takibe alınmıştır. Hastaların yaş-cins dağılımı, herni tipi, anestezi şekli, ortalama yatış süresi, erken ve geç komplikasyonları incelenmiştir. Bulgular: Postoperatif dönemdeki erken komplikasyonlar; idrar retansiyonu, yara enfeksiyonu ve hematom gelişmesi olarak gözlenmiştir. İdrar retansiyonu gelişen hastaların hepsine spinal anestezi uygulanmış olup, geçici idrar sondası takılması gerekti. Yüzeyel yara enfeksiyonu drenaj ve antibiyoterapi ile tedavi edildi. Hastaların geç dönem komplikasyonları incelendiğinde Schouldice herniorafi yapılan 1 hastada uylukta parestezi, lichtenstein herniorafi yapılan 1 hastada postoperatif 5.ayda nüks gelişti. Sonuç: Her cerrahın bilmesi gerektiğini düşündüğümüz bu tekniğin cerrahi eğitimi veren kurumlarda yeni yetişen cerrahlara alternatif bir yöntem olarak verilmesi gerektiğini düşünüyoruz. Cerrahiye bir alternatif sağladığı gibi, gerilimsiz tekniklerin uygulanamayacağı vakalarda doğrudan tercih edilebilir.