Melih Paksoy

Rupture of the Hydatid Disease of the Liver into the Biliary Tracts

Background: To analyze the diagnosis and the surgical treatment of intrabiliary ruptured hydatid disease of the liver. Methods: Between 1990 and 1995, 263 patients with hydatid cysts of the liver underwent surgery in a university hospital. Twenty-five (9.43%) patients with intrabiliary rupture of hepatic hydatid cyst were retrospectively reviewed. Results: Diagnosis was principally made using ultrasonography and computed tomography scanning and was confirmed by the findings of other tests. In 12 patients (48%) partial cystectomy with primary closure; 5 patients (20%) partial cystectomy with drainage; 5 patients (20%) cystotomy with drainage; 3 patients (12%) left hepatic resection (atypic, segmentary or lobar) was performed. Omentoplasty was performed in 6 patients. The common bile duct was explored in all patients and it was drained by a T-tube in 22 patients, and by a choledochoduodenostomy in 3 others. The average postoperative hospitalization time was 8.3 and 22.5 days in patients treated with choledochoduodenostomy and T-tube drainage respectively. Cholecystectomy was performed in 18 patients. Complications were seen in 4 patients (16%) with 1 pleural effusion and 3 wound infections. There was only 1 death (4%) due to duodenal peptic ulcus perforation with intrabiliary ruptured hydatid cyst. Conclusion: This study indicates that T-tube drainage and choledochoduodenostomy in intrabiliary ruptured hydatid cysts are effective procedures with low morbidity and mortality rates.

Value of diagnostic laparoscopy in tuberculous peritonitis.

OBJECTIVE To assess the safety and efficacy of diagnostic laparoscopy in patients with tuberculous peritonitis. DESIGN Retrospective clinical study. SETTING University hospital, Turkey. SUBJECTS 8 patients (2 women, 6 men; mean age 26 years) who presented with tuberculous peritonitis between January 1994 and January 1996. INTERVENTION Laparoscopy under local anaesthesia with sedation (the 4 who presented with ascites) and laparotomy (the 4 who presented with an acute abdomen). MAIN OUTCOME MEASURES Clinical and laboratory findings, biochemical and microbiological analysis of ascites, histopathological examination of specimens, morbidity, and mortality. RESULTS 4 patients presented with ascites, and 4 with adhesions. Ascites; adhesions between liver and diaphragm, liver and intestines, and intestines and the abdominal wall; miliary nodes on the peritoneal surface; and inflamed haemorrhagic areas on the peritoneum could all be seen at laparoscopy. One of the 8 patients who underwent laparotomy developed a spontaneous enterocutaneous fistula during the early postoperative period. Two of eight patients died, one of an early enterocutaneous fistula and the other of cor pulmonale 3 1/2 months later. The remaining 6 patients survived without complications after antituberculous medical treatment. CONCLUSIONS Laparoscopy is a safe and accurate method of diagnosis of tuberculous peritonitis.

Influence of age on prognosis and management of patients with colorectal carcinoma.

OBJECTIVE To see if the prognosis and management differed in patients with carcinoma of colon and rectum above and below 65 years of age. DESIGN Retrospective study. SETTING University hospital, Turkey. SUBJECTS 822 consecutive patients with colorectal carcinoma operated on between 1984 and 1994, 565 of whom were less than 65, and 257 of whom were 65 or more. MAIN OUTCOME MEASURES Factors that affected prognosis and management. RESULTS There were no significant differences between the two groups in mode of presentation, site and type of tumour, histological grade, incidence of curative and palliative operations, and postoperative morbidity and mortality. Obstruction and perforation were more common in the elderly group (p<0.0001). The postoperative (30 day) mortality was 3% in the younger group (20/565) and 7% in the older group (17/257). It was higher in those who were operated on as emergencies but was not significantly related to age. The actuarial five- year survival rates for older and younger patients were 33% and 45%, respectively (p<0.05). CONCLUSION Age alone has no characteristic effect on the treatment of colorectal carcinoma.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the breast

Inflammatory myofibroblastic tumor of the lung has often been reported but extrapulmonary cases are rare. Here we describe a case of inflammatory myofibroblastic tumor of the breast in a 60‐year‐old woman. This is only the eleventh case reported in the English language literature. The patient was free of disease 85 months after surgery.

Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions.

The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6–39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.

The Effect of Halofuginone, a Specific Inhibitor of Collagen Type 1 Synthesis, in the Prevention of Pancreatic Fibrosis in an Experimental Model of Severe Hyperstimulation and Obstruction Pancreatitis

BACKGROUND The aim of this paper is to assess the effects of halofuginone, a specific inhibitor of synthesis of collagen Type 1, on fibrogenetic process in an experimental model of early pancreatic fibrosis. METHODS Thirty rats were divided into three equal groups: group 1, sham laparotomy; group 2, severe hyperstimulation and obstruction pancreatitis (SHOP) with no treatment; group 3, SHOP with halofuginone treatment group. SHOP model was induced by complete pancreatic duct obstruction and daily cerulein hyperstimulation (50 microg/kg, intraperitoneally). Halofuginone was administered daily from the operative day (5 mg/kg, intraperitoneally). All of the animals were sacrificed, and blood and pancreatic tissue samples were obtained for biochemical and histopathological examination on the 5th postoperative day. RESULTS No mortality was observed in any group. Serum amylase, lipase, hyaluronic acid, and nitric oxide levels were significantly higher in groups 2 and 3 compared with group 1 (P < 0.05), but were significantly lower in group 3 compared with group 2 (P < 0.05). No significant differences were observed regarding serum malondialdehyde and glutathione levels between groups 1 and 3. Tissue hydroxyproline levels were found to be significantly higher in groups 2 and 3 compared with group 1 (P < 0.001), but were significantly lower in group 3 compared with group 2 (P < 0.001). Although tissue hydroxyproline levels were significantly higher in the halofuginone treatment group compared with the control group, histopathological evaluation did not reveal a significant difference between these groups regarding collagen deposition. When group 3 was compared with group 2, halofuginone significantly reduced inflammation and acinar atrophy in the pancreas as well (P < 0.05). CONCLUSION Halofuginone was found to be effective in reducing SHOP-related inflammation, acinar atrophy, and fibrosis in the pancreas.

Hyperbaric Oxygen and N-Acetylcysteine Treatment in L-Arginine-Induced Acute Pancreatitis in Rats

ABSTRACT Background: This study was designed to evaluate the combined effects of hyperbaric oxygen (HBO) and N-acetylcysteine (NAC) on acute necrotizing pancreatitis in rats. Methods: Experiments were performed in 50 male Wistar rats, which were divided into five groups (N = 10 for each group). The first group received normal saline (0.9% NaCl) intraperitoneal and served as the control group. In the second group, acute pancreatitis was induced by 3.2-g/kg body weight L-arginine intraperitoneal twice at an interval of 1 hr, which has been shown previously to produce severe necrotizing acute pancreatitis. In the third group, NAC treatment (1000 mg/kg) was given after 1 hr of the induction of acute pancreatitis twice 24 hr apart. In the fourth group, animals received HBO, 6 hr after the induction of pancreatitis twice 12 hr apart. In the fifth group, animals received together NAC as in Group 3 and HBO treatment as in Group 4. Groups 1, 2, and 3 were left under normal atmospheric pressures. Twelve hours after last treatment, the animals were killed by exsanguinations. Blood samples were studied for amylase, calcium, and lactate dehydrogenase (LDH), pancreatic histology, pancreatic tissue malondialdehyde, superoxide dismutase, and glutathione levels. Results: Acute pancreatitis is reduced by the treatment of NAC, HBO, NAC + HBO. HBO + NAC groups performed statistically the best in preventing L-arginine-induced acute necrotising pancreatitis. Conclusions: NAC especially combined with HBO, decreases oxidative stress parameters, serum amylase, calcium, and LDH levels, as well as histopathologic score.

The Effects of Cefephim, G-CSF, and Sucralfate on Bacterial Translocation in Experimentally Induced Acute Pancreatitis

Abstract The preventive effects of granulocyte colony-stimulating factor, cefephim, and sucralfate on bacterial translocation in experimentally induced acute pancreatitis were investigated. Forty male Wistar albino rats were used in this study. For each rat, the pancreatobiliary ductus was ligated and hence acute pancreatitis was induced. In the control group, no further procedure was performed. Meanwhile, cefephim as an antibiotic, filgrastim, which is a colony-stimulating factor, and sucralfate were given to the other groups at the specified doses. To inhibit bacterial translocation by preserving the bowel barrier, sucralfate, which is known to have a cytoprotective effect on the gastrointestinal system, was used in high doses. Cefephim 30 mg/kg per day (intramuscularly) in group II, filgrastim 10 mg/kg per day (subcutaneously) in group III, and sucralfate 50 mg/kg per day by 8-F feeding tube gavage into the stomach in group IV were given. The number of bacteria translocated into the mesenteric lymph nodes, pancreas, liver, and spleen in the control group significantly increased in comparison with the other groups (P < 0.05). The average number of leukocytes (per mm3) in the control group was significantly higher than that of other groups (P < 0.0001). Regarding the average serum amylase levels, the values of all groups clearly decreased in comparison with the control group (P < 0.0001). Although in the cefephim, filgrastim, and sucralfate groups, (+) pancreatitis was generally seen, in the control group (+++) pancreatitis was detected. Bacterial translocation to the mesenteric lymph nodes and pancreas was partially prevented by filgrastim and sucralfate, and was completely prevented by cefephim. We conclude that in the management of acute pancreatitis, the use of the prophylactic antibiotics, sucralfate and filgrastim, may be advantageous.

Cololaryngostomy procedure in caustic esophageal burns

The study presented herein was undertaken to report an original case of cololaryngostomy operation in caustic esophageal burns. Cololaryngostomy application to a chronic caustic esophageal burn case is reported with a detailed literature review of the topic. For the first time in the world, the larynx was used for the integrity of the gastrointestinal system by applying a cololaryngostomy procedure as it was found to be the only intact and reliable tissue in the operation. The patient started to gain weight in a 3-month period. Oral nutrition and speech were also achieved. Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx and esophagus is an important reconstructive problem. In reconstruction, the aim should be the supplementation of both oral nutrition and speech.

Sporcu fıtığı; güncel teşhis ve tedavi yöntemlerinin derlemesi

Groin pain is an important clinical entity that may affect a sportsmans active sports life. Sportsmans hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsmans hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsmans hernia at our hospital between 2011-2014, in light of current literature.