Murat Çakır

The Effects of Anti-Adhesion Materials in Preventing Postoperative Adhesion in Abdominal Cavity (Anti-Adhesion Materials for Postoperative Adhesions)

PurposeThe purpose of this study was to compare the effects of anti-adhesion materials in postoperative adhesions.Materials and MethodsRats were assigned to five groups: Group 1: Control. Group 2: chitin layers were used. Group 3: Na-hyaluronate / carboxymethylcellulose layers were used. Group 4: Na-hyaluronate gel was poured into the abdomen. Group 5: methylprednisolone was injected. The adhesion frequency and grade were scored according to Granat. Blood was taken for Hb, AST, BUN and albumin levels determination.FindingsThe adhesion frequencies (right and left) and grades were as follow in Groups; I: 82%, 91%, 2.63 ± 1.22; II: 8.3%, 25%, 0.58 ± 0.66; III: 17%, 33%, 1.08 ± 1.08; IV: 50%, 58%, 1.41 ± 1.44; V: 50%, 42%, 1.41 ± 1.50. The adhesion phase in all study groups was found significantly low compared to control group, p < 0.05. No difference was observed among serologic and hematological parameters in all groups.ConclusionAll the materials used significantly lowered the adhesion frequency and grade.

RF-Assisted Cystectomy and Pericystectomy: A New Technique in the Treatment of Liver Hydatid Disease

Background: Radiofrequency (RF) energy has been used for ablation and resection of liver tumors. Purpose: To present a new technique for the treatment of liver hydatid cyst disease. Material and Methods: Two patients with liver hydatid disease treated with RF energy cauterization and surgical resection are presented. Cystectomy was performed in a female patient aged 35 years and pericystectomy was carried out in another female patient aged 55 years using RF energy cauterization. Blood was not needed during the operation. RITA® System (RITA Model 1500 RF Generator, RITA Medical Systems, Inc., USA) was used during the procedure. Conclusion: Cystectomy and pericystectomy in liver hydatid disease can be successfully performed with the assistance of RF energy.

Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions

INTRODUCTION The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. METHODS The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. RESULTS Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 ± 1.42 for Group 1, 0.31 ± 1.15 for Group 2, and 0.20 ± 0.41 for Group 3. Adhesion stage of the Sterile Novuxol Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. CONCLUSIONS According to the results of our study, we believe that Sterile Novuxol can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness.

A rare coexistence of thyroid lymphoma with papillary thyroid carcinoma.

Diseases of the thyroid gland are frequently seen in general practice. Lymphoma of the thyroid is one of the rarest tumors. Its coexistence with papillary thyroid carcinoma is even rarer. Here, we present a 50-year-old female patient, who presented to our clinic with complaints of a rapidly growing lump on her neck, aphagia, and shortness of breath. A total thyroidectomy was performed. Histopathological analysis revealed the concomitant existence of papillary tumor. It should be noted that tumors with different histopathological behavior may rarely coexist with lymphoma in the thyroid gland. Masses growing rapidly in the thyroid shall suggest lymphoma.

Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation

A pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.

Primary pancreatic hydatid cyst resembling a pseudocyst

Hydatid cyst is a parasitic disease that is commonly seen in certain areas. It may localize in many organs in the body. Pancreas is a rarely involved organ. A 48 years old patient who could not be diagnosed before surgery was then diagnosed with hydatid cyst localized in the uncinate process of the pancreas post-operatively. Albendazole treatment was begun after the operation. No problem was observed in the follow-up ultrasonography. This rare case may be mistaken for cystic malignancies and pseudocysts of pancreas.

Gastrointestinal stromal tümörlerde prognozun belirlenmesinde preoperatif nötrofil lenfosit oranının etkisi

OBJECTIVE Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors. MATERIAL AND METHODS The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearsons correlation analysis and the Welch ANOVA test. RESULTS The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p<0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r=-0.32, p=0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r=-0.364, p=0.025). CONCLUSION The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis.

Ileosigmoidal knotting, an unusual form of acute intestinal obstruction

Ileosigmoidal knotting is an unusual form of acute intestinal obstruction characterized by closed‐loop obstruction of both ileum and sigmoid colon. We present 36 cases of ileosigmoidal knotting.

Gastric necrosis and perforation caused by acute gastric dilatation.

Acute gastric dilatation was first defined by Duplay in 1833. We herein present the case of a 55-year-old male patient diagnosed with gastric necrosis and perforation caused by acute gastric dilatation. Since the stomach has a rich blood circulation, necrosis and perforation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method in revealing the diagnosis and aetiology is computerized tomography. Medical treatment is appropriate for cases where no necrosis and peritonitis findings are detected through endoscopy. Delays in surgical treatment increase the risk of mortality.

In Patients Who Underwent Total Thyroidectomy Some Non-Steroidal AntiinflammatoryDrugs Effects on Thyroid Replacement Therapy

Objective: Non-steroid anti-inflammatory drugs can change serum thyroid hormone concentrations by binding to serum proteins. If misunderstood, this situation can give way to inappropriate diagnoses and faulty treatment planning for thyroid diseases in clinical practice. The purpose of our study was to investigate the effects of ketoprofen, lornoxicam, and etofenamate, which are frequently used in clinical practice, on thyroid function tests. Methodology: The study covered 28 rabbits divided into 4 groups. Groups were administered intramuscular injections daily for 10 days. Thyroid hormones concentrations were tested in the blood samples end of day 10. Results: An increase in free thyroxin level in the lornoxicam group was recorded on day 7 in comparison to other groups (p=0.015). There was a statistical decrease regarding thyroid stimulant hormone concentration after day 5 in all three groups (Day 5 p=0.000, day 7 p=0.003, day 10 p=0.00). Conclusion: We believe that previous history of non-steroid anti-inflammatory drug use should be taken into consideration within the scope of patients’ anamneses because non-steroid anti-inflammatory drug use can change the results of thyroid function tests and this change may lead to misevaluations and mistreatment not only for patients with thyroid diseases but also for normal patients.