Ismail Hakki Ozerhan

Comparison of hyperbaric oxygen and medical ozone therapies in a rat model of experimental distal colitis

Abstract Objectives. Previous studies have shown that hyperbaric oxygen (HBO) is effective in reducing the severity of acute distal colitis (ADC). Ozone therapy (OT) reduces inflammation in several pathological conditions. We aimed to compare the effects of HBO therapy and OT in an experimental ADC rat model. Materials and methods. Forty rats were randomly divided into four groups: Sham, ADC, ADC + HBO, and ADC + OT. Rats in the sham group were given isotonic saline. In the remaining groups, ADC was created by intracolonic administration of 4% acetic acid. No treatment was given to the ADC group. The rats in the ADC + HBO and ADC + OT groups were given HBO and ozone treatments, respectively. The administration of acetic acid caused an inflammatory response in all animals. Distal colons and blood samples were obtained. Results. The histopathological score was significantly higher in the ADC group compared to the other groups. The histopathological scores in the ADC + HBO and ADC + OT groups were significantly lower compared to the ADC group (both p < 0.001). The most pronounced therapeutic effect was observed in the ADC + OT group. Malondialdehyde and neopterin levels and superoxide dismutase and glutathione peroxidase activities in the ADC group were significantly higher compared to the other groups (p < 0.001). Conclusion. Our data showed that the therapeutic effect of OT is more pronounced than that of HBO therapy. Its possible effect is by means of decreasing inflammation, edema, and oxidative stress. These findings also suggest that it is possible to improve the outcome of ADC by using ozone therapy as an adjuvant therapy.

Biliary fistula after treatment for hydatid disease of the liver: when to intervene.

AIM To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid disease of the liver. METHODS Between January 2000 and December 2010, out of 301 patients with a diagnosis of hydatid cyst of the liver, 282 patients who underwent treatment [either surgery or puncture, aspiration, injection and reaspiration (PAIR) procedure] were analysed. Patients were grouped according to the presence or absence of postoperative biliary fistula (PBF) (PBF vs no-PBF groups, respectively). Preoperative clinical, radiological and laboratory characteristics, operative characteristics including type of surgery, peroperative detection of BF, postoperative drain output, morbidity, mortality and length of hospital stays of patients were compared amongst groups. Multivariate analysis was performed to detect factors predictive of PBF. Receiver operative characteristics (ROC) curve analysis were used to determine ideal cutoff values for those variables found to be significant. A comparison was also made between patients whose fistula closed spontaneously (CS) and those with intervention in order to find predictive factors associated with spontaneous closure. RESULTS Among 282 patients [median (range) age, 23 (16-78) years; 77.0% male]; 210 (74.5%) were treated with conservative surgery, 33 (11.7%) radical surgery and 39 (13.8%) underwent percutaneous drainage with PAIR procedure A PBF developed in 46 (16.3%) patients, all within 5 d after operation. The maximum cyst diameter and preoperative alkaline phosphatase levels (U/L) were significantly higher in the PBF group than in the no-PBF group [10.5 ± 3.7 U/L vs 8.4 ± 3.5 U/L (P < 0.001) and 40.0 ± 235.1 U/L vs 190.0 ± 167.3 U/L (P = 0.02), respectively]. Hospitalization time was also significantly longer in the PBF group than in the no-PBF group [37.4 ± 18.0 d vs 22.4 ± 17.9 d (P < 0.001)]. A preoperative high alanine aminotransferase level (> 40 U/L) and a peroperative attempt for fistula closure were significant predictors of PBF development (P = 0.02, 95%CI: -0.03-0.5 and P = 0.001, 95%CI: 0.1-0.4), respectively. Comparison of patients whose PBF CS or with biliary intervention (BI) revealed that the mean diameter of the cyst was not significantly different between CS and BI groups however maximum drain output was significantly higher in the BI group (81.6 ± 118.1 cm vs 423.9 ± 298.4 cm, P < 0.001). Time for fistula closure was significantly higher in the BI group (10.1 ± 3.7 d vs 30.7 ± 15.1 d, P < 0.001). The ROC curve analysis revealed cut-off values of a maximum bilious drainage < 102 mL and a waiting period of 5.5 postoperative days for spontaneous closure with the sensitivity and specificity values of (83.3%-91.1%, AUC: 0.90) and (97%-91%, AUC: 0.95), respectively. The multivariate analysis demonstrated a PBF drainage volume < 102 mL to be the only statistically significant predictor of spontaneous closure (P < 0.001, 95%CI: 0.5-1.0). CONCLUSION Patients with PBF after hydatid surgery often have complicated postoperative course with serious morbidity. Patients who develop PBF with an output < 102 mL might be managed expectantly.

FASCIN EXPRESSION IN COLORECTAL CARCINOMAS

PURPOSE The purpose of this study was to investigate the significance of fascin expression in colorectal carcinoma. METHODS This is a retrospective study of 167 consecutive, well-documented cases of primary colorectal adenocarcinoma for which archival material of surgical specimens from primary tumor resections were available. We chose a representative tissue sample block and examined fascin expression by immunohistochemistry using a primary antibody against “fascin”. We calculated the “immunohistochemical score (IHS)” of fascin for each case, which was calculated from the multiplication of scores for the percentage of stained cells and the staining intensity. RESULTS Fascin immunoreactivity was observed in 59 (35.3%) of all cases with strong reactivity in 24 (14.4%), moderate reactivity in 25 (14.9%) and weak reactivity in 10 (6.0%) cases. Strong/moderate immunoreactivities were mostly observed in invasive fronts of the tumors or in both invasive and other areas. Fascin immunoreactivity scores were significantly higher in tumors with lymph node metastasis (p:0.002) and advanced stage presentation (p:0.007). There was no relation between fascin expression and age, gender, depth of invasion, distant metastasis or histological grade (p>0.05). There was a higher and statistically significant correlation between fascin immunoreactivity in the invasive borders of tumors and lymph node metastasis (r:0.747, p:0.005). In stage III/IV tumors, two-year survival was 92.2% in tumors without fascin immunoreactivity, and only 60.0% in tumors with a fascin IHS>10 (p:0.003). CONCLUSION These findings suggest that fascin is heterogeneously expressed in approximately one third of colorectal carcinomas with a significant association with lymph node metastasis, tumor stage and location. Moreover, these results indicate that fascin may have a role in the lymph node metastasis of colorectal carcinomas.

Melatonin prevents peritoneal adhesions in rats

Background and Aim:  Intra‐abdominal adhesions are important postoperative complications following abdominal surgery. The adhesions that develop form the basis of more advanced pathology such as intestinal obstruction or infertility. Melatonin is secreted from the pineal gland in a circadian pattern; this molecule has potent antioxidant characteristics and has beneficial effects in many models of inflammation. The aim of this study was to evaluate the effects of melatonin on peritoneal adhesions created in rats.

Invasive Pulmonary Aspergillosis after Liver Transplantation: Rapid and Complete Response to Combined and Sequential Antifungal Therapy

BACKGROUND Invasive pulmonary aspergillosis is a rare, but severe and potentially fatal, complication after liver transplantation. There is no therapeutic regimen accepted worldwide for both initial and continuation therapy; nevertheless, several options have been proposed. METHODS Case report and review of the pertinent English-language literature. RESULTS In a patient with pulmonary aspergillosis after a liver transplant, combined and sequential therapy with caspofungin and voriconazole with termination of the immunosuppressive regimen and careful management were helpful to control the infection rapidly, possibly because of a positive drug interaction. CONCLUSION In cases of invasive aspergillosis that are refractory to monotherapy, this regimen may be used in an attempt to overcome the infection.

Who is responsible for inadequate lymph node retrieval after colorectal surgery: surgeon or pathologist?

Abstract Background : Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes. Methods : We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis non-parametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated. Results : There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049). Conclusions : Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.

Antikoagülan tedavinin tetiklediği spontan karaciğer hematomu: Olgu sunumu

GIRIŞ Spontan karaciger hematomu (SKH) oldukca nadir gorulur ve basta hepatoselluler kanser olmak uzere karaciger hastaliklari en onemli sebebidir (1). Antikoagulan tedavi gunumuzde ozellikle yasli populasyonda artan siklikla kullanilmaktadir ve buna bagli olarak da kanama komplikasyonlari gorulebilmektedir. Calismamizda antikoagulan kullanimina bagli olarak gelisen SKH’lu olguya yaklasimi paylasmayi amacladik.

Recurrent Inguinal Hernia and Reservoir Migration after Three-Piece Penile Prosthesis Implantation

Corresponding Author: Ozcan Altınel, General Surgeon. Department of Emergency Medicine, Etlik, 06018, Ankara, Turkey. Phone: +903123043076 · GSM: +905354959283 · E-mail: ozcanaltinel@yahoo.com Özet 60 yaşında sağlıklı erkek hastaya erektil disfonksiyon nedeni ile penil protez imp¬lantasyonu uygulanmadan bir yıl önce bilateral inguinal herni ameliyatı uygulan¬mıştır. Operasyondan 3 ay sonra rezervuarın yerleştirildiği sol inguinal bölgede nüks inguinal herni gözlendi. Rezervuar hem herniye ve aynı zamanda migrate idi. Penıl protez implantasyonu ameliyatlarının bir çok komplikasyonu olsada, rezer¬vuar alanında nüks inguinal herni komplikasyonu oldukça nadirdir. Penil protez rezervuarın yerleşimi ve transvers fasiyaya baskısı sonucu olası duvar zayıflıkları rekürrens olasılığını hızlandırabilirler. Cerrah, mutlaka Penile prosthesis implantas¬yonu öncesi inguinal kanalı dikkatlice muayene etmeli ve herni durumlarında tamir için tension free yöntemleri uygulanmalıdır.

Primary Cyst Hydatidosis of Pelvis with Groin Pain and Limb: A Case Report

Echinococcosis may involve all organs of body; however, primary pelvic cyst hydatid involving bone with groin and anterior hip pain is very rare. We presented a case of extensive pelvic cyst hydatidosis involving bone without pathological fracture, in a 22-years-old man. First symtoms of patient was groin and anterior hip pain and limb. The diagnosis was made clinico-radiologically and the patient was cured with enbloc resection and filling bone cement. The patient was relieved completely one year after surgery. Cyst hydatid should be included in the differential diagnosis in patients with groin and anterior hip pain, although pelvic cyst hydatoid result in urinary, genital and abdomen problems. Much hydatid disease can be cure by administration of antihelminthic drugs, however, curettage and bone cementing is good choice in patient involving bone to eliminate recurrences and bone fracture.

Clinical and prognostic significance of preoperative and postoperative neutrophil/lymphocyte ratio and platelet/ lymphocyte ratio in patients undergoing major abdominal surgery

Aims: Acute inflammatory processes are associated with perioperative complications. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were reported to have prognostic importance in various diseases. We aimed to investigate the clinical importance of preoperative (preop) and postoperative (postop) NLR and PLR as predictors of morbidity and surgical or nonsurgical complications after major abdominal surgery. Methods: Patients who had a major abdominal surgery were retrospectively evaluated. Age, gender, American Society of Anesthesiologist (ASA) score, and the type of operation were recorded. Preop and postop days 1, 3 and 5 white blood cell (WBC), neutrophil, lymphocyte and platelet counts, duration of intensive care unit stay and hospitalization, Clavien Dindo classification, and surgical or non-surgical complications were determined. Results: The study included 462 subjects. Concerning increased need for red blood cell transfusions, NLR was significantly higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 compared to preop state. Regarding a worse ClavienDindo classification, NLR was higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 and 3 compared to baseline. In those with increased surgical complications, NLR was lower on postop day 5, and postop day 1 and 3 PLR were higher compared to baseline values. In subjects with higher non-surgical complications, NLR was higher on postop day 3 but lower on day 5 compared to preop measurements. PLR was similar across the days of follow up in terms of non-surgical complications. Conclusions: Higher NLR on postoperative day 5, and higher PLR on postoperative days 1 and 3 compared to preop values were the indicators of increased complications in this study.