Ilhami Taner Kale

In Vitro Effectiveness of Different Chemical Agents on Scolices of Hydatid Cyst

In the surgical history of hepatic hydatid disease, multiple scolicidal agents have been used for sterilization of the cyst contents. However, none of these agents can be safely used, because most have unacceptable side effects, such as toxicity, caustic sclerosing cholangitis, bile duct stricture, and hypernatremia. Protoscolices were aseptically removed from liver hydatid cysts obtained from sheep slaughtered at the municipal abattoir in Kahramanmaras, Turkey. In this study, the effects of 0.9% NaCl (control group), 20% NaCl (hypertonic saline), 20% silver nitrate, albendazole 20 mg/cm3, 50% dextrose (hypertonic glucose), and 20% mannitol and aminomix-1 solutions on echinococe cysts were investigated under in vitro conditions. After 5, 10, 15, 20, 25, 30, 45, and 60 min for each concentration, the first 100 protoscolices were counted on the 10× microscopical field. Protoscolices, which showed positive staining by eosine were considered as dead ones. The averages of dead and total protoscolices were calculated. Our results showed that all observed protoscolices were dead after the treatments by 20% silver nitrate in 20 min, by 50% dextrose and by aminomix-1 solution in 30 min, and by 20% NaCl and by 20% mannitol in 45 min. Albendazole at 20 mg/cm3 was observed to lead to death of 65% of protoscolices in the first 5 min and 70% of protoscolices at the end of 60 min. Compared with 0.9% NaCl (saline), all of these scolicidal agents were significantly effective (p <. 05). Aminomix-1, 20% mannitol, and 50% dextrose solutions may be used in percutaneous and surgical treatment of hydatid cyst. They may be preferred because they are readily available, can be administered intravenously, and have an equal or greater effectiveness than 20% hypertonic saline.

Effects of Intravenous Anesthetics on Renal Ischemia/Reperfusion Injury

Background. Renal ischemia/reperfusion (I/R)-induced tubular epithelial cell injury, called ischemic acute renal failure, is associated with high mortality in humans. Protecting the kidney against I/R injury is very important during complicated renal operations, transplantation surgery, and anesthesia. Aim. The purpose of this study was to investigate and compare the efficiency of ketamine, thiopental, propofol, etomidate, and intralipid in reducing the injury induced by free radicals in a rat model of renal I/R. Method. Forty-two Wistar rats were divided into seven groups in our study. Rats in the sham group underwent laparotomy and waited for 120 minutes (min) without ischemia. Rats in the control group were given nothing with ischemia-reperfusion. Rats in the I/R groups were given ketamine (20 mg/kg), thiopental (20 mg/kg) propofol (25 mg/kg), etomidate (10 mg/kg) and 10% intralipid (250 mg/kg) intraperitoneally 15 min prior to the ischemia for 60 min, followed by reperfusion for 60 min. The blood samples and kidney tissues of the rats were obtained under anesthesia at the end of the reperfusion period. Biochemical malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), blood urea nitrogen (BUN), creatine (Cr), aspartate aminotransferase (AST) were determined, and histopathological analysis was performed with these samples. Results. MDA level was increased significantly in the control group (p < 0.05). Histopathological findings of the control group confirmed that there was renal impairment by tubular cell swelling, interstitial edema, medullary congestion, and tubular dilatation. MDA levels were lower in the ketamine, thiopental, and propofol groups compared to the control group (p < 0.05). In the thiopental and propofol groups, the levels of histopathological scores were significantly lower than control and etomidate groups in ischemia-reperfusion. Conclusion. Our results demonstrated that I/R injury was significantly reduced in the presence of propofol and thiopental. The protective effects of these drugs may belong to their antioxidant properties. These results may indicate that propofol and thiopental anesthesia protects against functional, biochemical, and morphological damage better than control in renal I/R injury.

Administration of honey to prevent peritoneal adhesions in a rat peritonitis model

AIM We investigated the effects of intraperitoneal honey on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis. METHODS Bacterial peritonitis was induced in 18 rats by cecal ligation and puncture. The rats were randomly assigned to three groups. Group 1 (n=6) received honey intraperitoneally, group 2 (n=6) received 5% dextrose intraperitoneally, and the third group received no fluid or medicine intraperitoneally one day after cecal ligation and puncture procedure. All animals were killed 14 days later so we could assess the adhesion score. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall. RESULTS Adhesion scores of honey treated group were significantly lower according to the control group (P<0.05) and statistically significant. Adhesion scores of honey were lower from 5% dextrose but not statistically significant (P>0.05). Malondialdehyde values of honey group were significantly lower from the control group (P<0.05) and levels in 5% dextrose group was higher than the honey group. Catalase levels were high in control and 5% dextrose groups. Superoxide dismutase levels were higher in the control group than the honey group (statistically significant). CONCLUSIONS Intraperitoneal honey decreased the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Honey also decreased the oxidative stress during peritonitis.

Prevention of postoperative peritoneal adhesions by administration of estrogen.

Aim: Postoperative abdominal adhesions represent one of the most common causes of intestinal obstruction in surgical patients. In this study, the effects of intraperitoneal administration of estrogen on the development of postoperative intraabdominal adhesions and peritoneal leucocytes in a rat adhesion model were investigated. Methods: Sixty Wistar albino rats were divided into three groups. Group 1 (control group) had their abdomen closed after surgery without administration of any material or drug. Group 2 (saline group) received 2 ml of 0.9% NaCl, and group 3 (estrogen group) animals received a single intraperitoneal dose of 2 cc (1 mg) estrogen (Estradiol propionate, 50.000U, Akrofilline®, Biofarma, Turkey). All the groups were exposed to the same adhesion-creating procedure (Swolin K. Experimental studies on the prevention of intra-abdominal adhesions. Studies on rats with an emulsion of lipid and prednisolone. Acta Obstet Gynecol Scand. 1966;45:473–498.). After 7–42 days, all animals were sacrificed. Adhesions were scored and peritoneal leucocytes were counted. Results: The adhesion formation and peritoneal leucocyte count of the estrogen group were significantly less than the control and saline groups and a statistically significant difference was determined in comparison of those groups (p <. 05). Conclusion: We concluded that intraperitoneal estrogen decreases the incidence of postoperative intraabdominal adhesion formation in rat adhesion model.

Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study

AIM To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinical parameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric Mann-Whitney U test was used to compare quantitative data that were not normally distributed, and Pearson’s chi-squared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method. RESULTS This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy (P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively. CONCLUSION This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.

Assessment of risk factors affecting mortality in patients with colorectal cancer

Introduction The most important risk factors for colorectal cancer are age, high ASA score, anemia, low albumin, tumor stage, histopathological properties, tumors relationship with adjacent tissues, positivity of surgical borders and timing of the surgical procedure. Aim To determine possible risk factors for mortality in patients undergoing colorectal cancer surgery. Material and methods The medical records of 101 consecutive patients who underwent colorectal cancer surgery at the Department of Surgery, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey between January 2008 and November 2015 were retrospectively reviewed. The patients were divided into two groups: surviving (n = 76) and deceased (n = 25) groups. The groups were compared in terms of several demographic, clinical, biochemical, and histopathological parameters. In addition, risk factors for mortality were analyzed with multivariate analysis. SPSS 22.2, PAST 3, and MedCalc 14 software packages were used for statistical analyses. Results The surviving and deceased groups significantly differed with respect to age (p = 0.001), hemoglobin (p = 0.001), lymph node positivity (p = 0.009), positive lymph node/total lymph node ratio (p = 0.012), thrombocyte count (p = 0.047), lymphovascular invasion (p = 0.028), urgency of admission (emergency/elective) (p = 0.036), and postoperative carcinoembryonic antigen (CEA) level (p = 0.002). A receiver operating characteristics curve was drawn to determine the cut-off values of various parameters including age (63), hemoglobin (12.8), node positivity (3), positive/total lymph node ratio (0.435) and thrombocyte count (308), with age (p < 0.001), hemoglobin (p < 0.001), node positivity (p = 0.025) and positive/total lymph node ratio (p = 0.024) being significantly different. A multivariate analysis revealed that age (p = 0.049), hemoglobin (p = 0.045), and positive/total lymph node ratio (p = 0.025) were independent risk factors for mortality. Conclusions This study shows that older age, lower hemoglobin level, and high positive/total lymph node ratio were independent risk factors for mortality among colorectal cancer patients.

Clinicopathological analysis of appendiceal mucinous tumors: A single-center experience

Objective Appendiceal mucinous tumors can be encountered in four different types. The clinical approach varies according to these types and the severity of the present disease. We aimed to share clinical, radiological, and pathological features and surgical options of the patients diagnosed with mucinous tumors at our center. Material and Methods Between August 2009 and March 2016, 757 patients underwent appendectomy for presumed diagnosis of acute appendicitis at the Department of Surgery, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey. Among them, demographic, clinical, and histopathological characteristics of patients who diagnosed with appendiceal mucinous tumors were retrospectively analyzed. This study was approved by our facultys human ethics committee. Results Incidence of mucinous tumor was 1.71%. Mean age of a total of 13 cases including 6 women and 7 men was 52.4±21.6 years (Range: 25-83 years). On preoperative diagnosis, acute appendicitis was detected in 8 patients, perforated appendicitis and periappendiceal abscess in two patients, and suspicious cecal mass in two patients. One patient had an operation for uterine leiomyoma. On histopathological examination, four patients were diagnosed with simple mucinous cyst, four with mucinous cystadenoma, three with mucosal hyperplasia, and two with mucinous cystadenocarcinoma. Mean duration of hospital stay was 5.1±4.7 days. One patient died from septic shock on first day, one from respiratory failure on 14th day, and one from cardiac arrest on 20th day. The average follow-up duration for the other 10 patients was 44 months (ranging from 1 to 78 months). No recurrence or death occurred in these patients over the course of follow-up. Conclusion Intraoperative clinical diagnosis of appendiceal mucinous tumors is rarely seen. Close histopathological and cytological examination of the specimen is required to separate malignant tumors from benign ones. The treatment varies depending on different types and the severity of the disease.

Neglected Fournier’s Gangrene Caused by Acinetobacter baumannii: A Rare Case Report

Fourniers gangrene, rare but life threatening disease, is characterized by an acute necrotic infection of the scrotum, penis, or perineum. Fourniers gangrene is a mixed infection caused by both aerobic and anaerobic bacteria. Fourniers gangrene caused by multidrug resistant Acinetobacter baumannii have been reported rarely. The mainstay of treatment is prompt recognition and a combination of antibiotics with radical debridement. We describe a case of a 56-year-old male patient presenting with neglected Fourniers gangrene caused by Acinetobacter baumannii. Many treatment modalities including broad-spectrum antibiotics, aggressive debridement, negative pressure wound therapy, diversion colostomy, and partial-thickness skin grafts were applied to save the patients life.