Mithat Kerim Arslan

Surgical treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. The purpose of this study was to assess the clinical features and results of surgical treatment of hepatic hydatid cysts.

Oral Nifedipine in the Treatment of Chronic Anal Fissure

Background: The purpose of this study was to demonstrate the effect of oral nifedipine on maximal resting anal pressure (MRAP) in healthy volunteers and to evaluate its role in the treatment of chronic anal fissure (CAF). Methods: MRAP was measured in 10 healthy volunteers and 10 patients with CAF before and after oral nifedipine (20 mg b.i.d.). Patients were assessed on the first visit and every fortnight for measurement of MRAP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatments were continued until healing had occurred or for up to 8 weeks. Results: MRAP values before and after nifedipine were 73.2 and 49.3 cm H2O, respectively, in healthy volunteers (p < 0.001). Nifedipine caused a reduction in mean MRAP from 105.2 to 74.0 cm H2O (p < 0.001) in patients with CAF. Pain scores were significantly reduced after 2 weeks of treatment with nifedipine (p < 0.001) and continued throughout the treatment period. At the end of the study 6 of the 10 patients treated with nifedipine were deemed to be healed (n = 5) or improved (n = 1). Headache occurred in 1 patient. Conclusion: We conclude that oral nifedipine is effective in reducing MRAP and should become the first-line treatment for CAF.

ACALCULOUS CHOLECYSTITIS CAUSED BY SALMONELLA PARATYPHI B INFECTION IN A CHILD WITH ACUTE PRE-B-CELL LYMPHOBLASTIC LEUKEMIA

Acute acalculous cholecystitis (AC) rarely occurs in children with acute leukemia. The principal treatment modality of AC is emergency surgery. Medical treatment of AC is not a good therapeutic approach. The mortality rate of AC is approximately 100% for medical treatment and 10-15% for emergency surgery. A 9-year-old boy with acute pre-B-cell lymphoblastic leukemia and AC caused by Salmonella paratyphi B infection is presented. He was successfully treated with cefepime, amikacin, and granulocyte-colony stimulating factor (G-CSF). These treatment combinations led to uneventful recovery after 21 days. It appears that AC in children with acute leukemia may be treated with appropriate intravenous antibiotics. This may be the first case of AC caused by Salmonella paratyphi B infection reported in a child with acute pre-B-cell lymphoblastic leukemia.

Spontaneous Peritoneal Rupture of Gastric Stromal Tumor.

Gastrointestinal stromal tumors (GISTs) originate from the mesenchyme of the digestive tract and express the c-kit proto-oncogene protein [1]. They generally originate from the stomach, small intestine, colon and rectum, peritoneum, omentum, esophagus, and retroperitoneal space [2–4]. Tumors originating from the stomach may present with abdominal pain, gastrointestinal bleeding, or a palpable mass. A rare presentation of stomach GISTs is extra-gastric growth and peritoneal rupture presenting as hemoperitoneum [5–7]. We here presented a patient with spontaneous peritoneal rupture of a gastric stromal tumor.

Kolorektal cerrahide ASEPSIS yöntemiyle yara takibi

GIRIŞ Kolorektal cerrahi geciren hastalar Yara yeri enfeksiyonlari (YYE) acisindan yuksek riske sahiptir (1,2). Yara yeri komplikasyonlarinin yakindan izlemi yara iyilesmesi ve hasta sag kalimi uzerinde olumlu etki yapmaktadir (3-8). Bu calismadaki amaclar kolorektal cerrahide YYE gelismesine neden olan faktorleri arastirmak, YYE siddetini ve iyilesme surecini yara skorlama yontemi olan ASEPSIS ile izlemek ve YYE riskini belirlemek amaciyla kullanilan NNIS (National Nosocomial Infections Surveillance System) ve SENIC (The Study on the Efficacy of Nosocomial Infection Control) yontemlerini karsilastirmaktir (4-12).

Intensive Pulmonary Care After Liver Surgery: A Retrospective Survey From a Single Center

BACKGROUND Prevention from postoperative pulmonary complications (PPCs) has been an important topic. The aims of this study were to determine the risk factors for PPC after liver surgery and to analyze the efficacy of postoperative pulmonary care on PPC prevention. MATERIALS AND METHODS We retrospectively analyzed variables of 81 patients who underwent hepatectomy and 4 transplantations between January 2007 and March 2012. RESULTS Nineteen patients suffered PPCs (22.4%). Bivariate analysis identified four risk factors: preoperative anemia (odds ratio [OR] = 5.69), the American Society of Anesthesiologists (ASA) score of 3 or 4 (OR = 5.36), blood transfusion (OR = 2.81), and prolonged operative time (OR = 1.01). Upon multivariate analysis, only prolonged operative time was an independent risk factor for PPC (OR = 1.01). Pulmonary function test (PFT) was performed for 22 of 41 patients with an ASA score ≥ 2 (53.7%); there was no significant relationship between abnormal PFTs (n = 13) and the development of PPCs (P = .12). CONCLUSIONS The elimination of risk factors may reduce the incidence of PPCs. Postoperative intensive pulmonary care should be given to all patients after liver surgery but particularly to patients with high ASA scores and those with abnormal PFTs irrespective of age.

The Effects of Bile Duct Obstruction on Liver Volume: An Experimental Study

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group (n = 4) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (P = 0.01). It was increased up to 60% of baseline values 25 days after BDL (P = 0.002). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (P = 0.002). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.