Mustafa Girgin

Pilonidal sinus treated with crystallized phenol: an eight-year experience.

PURPOSEThe aim of this study was to determine the impact of crystallized phenol on the outpatient treatment of pilonidal disease.PATIENTS AND METHODS:A retrospective analysis was undertaken of patients seen in the outpatient surgery clinic of the University Hospital, Elazıg, Turkey. Age, gender, body mass index, characteristics of sinuses at initial presentation, and the recovery time of 41 patients were analyzed. The relationship between recovery time and the number of sinus openings, presence of abscess, and status of the sinuses (acute vs. chronic) were noted.RESULTSCrystallized phenol was applied a total of 107 times on 41 patients. Seventy percent of the patients had two to three applications. Mean recovery time was 42.7 (± standard deviation of 24) days with a range of 13 to 120 days. Recurrences were observed in only two patients at the fifth and eighth months following recovery. The success rate was 95.1 percent. Median follow-up was 24 (range, 6–98) months. The status of sinuses (acute vs. chronic and presence or absence of abscess) and the number of sinus opening had no effect on recovery time (P > 0.005).CONCLUSIONCrystallized phenol treatment is a simple and inexpensive method that can be readily applied on an outpatient basis, decreasing both the recurrence rate and lost work time. We suggest that this method be considered the first-line treatment of any type of pilonidal sinus.

Comparison of Kugel and Lichtenstein Operations for Inguinal Hernia Repair: Results of a Prospective Randomized Study

IntroductionThe aim of this prospective randomized clinical study was to compare the Lichtenstein hernia repair with Kugel’s patch hernia repair.MethodsFrom September 1999 to August 2002, adult patients with inguinal hernia were randomized into two groups. Group I included patients with the Lichtenstein hernioplasty, and group II included patients with the Kugel hernioplasty. The duration of the operation, surgical findings, and postoperative complications were recorded for the patients in both groups.ResultsA total of 139 patients (134 men, 5 women) were randomized to either group I or group II. No significant differences were observed for the duration of the operation or the complication rates between the groups during the same follow-up time (53.06 ± 5.6 months vs. 53.41 ± 7.11 months in groups I and II, respectively).ConclusionsKugel herniorraphy is a minimally invasive method and as safe as the Lichtenstein hernia repair technique, with similar complication rates.

The Effects of Intraperitoneal Sildenafil Administration on Healing of Left Colonic Anastomoses and Intra-Abdominal Adhesion Formation in the Presence of Intra-Abdominal Infection

PurposeThe objective of this pilot study was to establish an animal model for intra-abdominal infection and to examine the effect of sildenafil on anastomotic healing of the left colon and intra-abdominal adhesion formation.MethodsFourteen Winstar rats underwent colonic transsection and primary anastomosis after performing intra-abdominal infection. Rats were divided into two groups: Group 1 (n = 7): intra-abdominal infection, resection, and anastomoses; Group 2 (n = 7): intra-abdominal infection, resection, anastomoses, and sildenafil. Anastomotic bursting pressures, hydroxyproline levels, histopathologic grading, and abdominal adhesions were accessed on the postoperative Day 7.ResultsAnastomotic healing was found to be improved in terms of a bursting pressure (P = 0.02). Histopathological examination revealed an increase in angiogenesis (P = 0.007). Moreover, intra-abdominal adhesions were significantly less in rats given sildenafil (P = 0.03).ConclusionSildenafil may improve anastomotic healing of the left colon and diminishes peritoneal adhesion formation in the presense of abdominal infection.

Minimally Invasive Treatment of Pilonidal Disease: Crystallized Phenol and Laser Depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.

Effects of trimetazidine in acute pancreatitis induced by L-arginine

BACKGROUND In acute pancreatitis, oxygen free radicals (OFRs) and cytokines have been shown to play a role in the failure of pancreatic microcirculation and the development of local tissue damage. We studied the effects of trimetazidine (TMZ), a potent antioxidant and anti-ischemic agent, on acute pancreatitis. METHODS Rats were randomized into 3 groups: a control group (n = 15), a study group (n = 15) in which acute pancreatitis was induced with with L-arginine, and a treatment group (n = 15) in which pancreatitis was induced and treated with TMZ intraperitoneally. The rats were followed for 24 hours. At the 24th hour we determined serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lactate dehydrogenase (LDH), interleukin 1-β (IL-1β), interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α), and the pancreatic tissues were analyzed histopathologically. RESULTS The AST (p < 0.001), ALT (p < 0.01), amylase (p < 0.001), LDH (p < 0.01), TNF-α (p < 0.01), IL-1β (p < 0.001) and IL-6 (p < 0.001) levels, and pancreatic tissue edema (p < 0.01), hemorrhage (p < 0.05), acinar cell necrosis (p < 0.001) and level of perivascular inflammation (p < 0.01), were significantly lower in the treatment group than the study group. CONCLUSION Trimetazidine markedly decreases biochemical and histopathologic changes during the early stages of acute pancreatitis, thus preserving the pancreas histologically.

Uncomplicated Hydatid Cysts of the Liver: Clinical Presentation, Diagnosis andTreatment

Hydatid cyst of the liver is zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus and is still endemic in the South European regions, Asia, South America, North Africa, Australia, New Zealand and several Asian and European countries. The diagnosis of non complicated hydatid cyst of the liver depends on clinical suspicion. They appear in two ways as general (systemic) symptoms, and local symptoms based on the site and organ on which larva settles. While cysts sometimes recover spontaneously, more severe clinical presentations are observed in immunosuppressive individuals. Ultrasonography is the gold standard diagnostic tool and E. Granulosus antigen 5 (Ag5) and antigen B (Ag B) obtained from cyst fluid are used as a serologic diagnostic method in combination with the imaging method. The current treatment of hydatid cyst of the liver varies from surgical intervention to minimally invasive treatments (percutaneous drainage) or medical therapies. Surgery is still the best treatment tool. Percutaneous drainage and treatment of the cyst is a good option to surgery in selected cases. Multiple, superficial single cysts are the most suitable ones for surgical treatment. Also for complicated infected cysts pressing biliary tree and vital organs, surgery should be the first choice of treatment coming to mind. We believe that the laparoscopic approach should be safe to uncomplicated cysts. The purpose of our article is to provide a current review of clinical, diagnostic, and therapeutic features of hydrated cyst diseases.

Incidentally diagnosed liver and right iliac muscle hydatid disease

Hydatid cyst disease is localized in the liver and lungs in most of the cases, but also can exist throughout the body. In this article, we present a 20-year-old male patient who was diagnosed with hydatid cyst of the liver and iliac muscle, who presented because of respiratory problems. Especially in endemic areas, in patients who are detected as having hydatid cyst in the liver, systemic examinations must be cattied out and investigated regarding any involvement of other organs.

Akut biliyer pankreatitte laparoskopik kolesistektomi

Biliyer pankreatitli olgularda safra tasi hastaliginin ortadan kaldirilmasi, ileride olusabilecek pankreatit ataklarini onler. Ancak kolesistektomi icin en uygun zaman konusunda fikir birligi yoktur. Hafif akut biliyer pankreatitli (ABP) hastalarda klinik ve laboratuar olarak iyilesmenin ardindan, hasta taburcu edilmeden laparoskopik kolesistektomi (LK) uygulanmasinin hem guvenli, hem de daha sonra gelisebilecek akut pankreatit ataklarinin onlenmesi acisindan gerekli oldugu bildirilmistir. Ancak calismalarin cogunda hafif ABP’li hastalar degerlendirilmektedir. Şiddetli ABP’li hastalarda LK ve zamanlamasi konusunda yeterince kanit bulunmamaktadir (2,3). Yapilan calismalarin cogunda ABP’li hastalar kendi icerisinde incelenmis olup, bu hastalarin diger nedenlerle LK uygulanan hastalarla karsilastirildigi calisma sayisi oldukca azdir. Bu calismanin amaci, ABP gecirmis LK uygulanan olgular ile semptomatik safra kesesi tasi (SST) nedeni ile LK uygulanan olgularin sonuclarini karsilastirmaktir. ARAŞTIRMA YAZISI

An unusual case of hematemesis and epistaxis caused by a pheochromocytoma

Pheochromocytoma is a rare catecholamine-secreting neoplasm that is the cause of hypertension in <0.2% of patients with hypertension. We encountered an unusual case of pheochromocytoma involving hematemesis and epistaxis episodes with accompanying hypertensive attacks. Venous ectasia was detected in the esophagus. Abdominal magnetic resonance imaging revealed an adenoma in the left adrenal region. The present case illustrates that pheochromocytoma can mimic different clinical conditions.

Mixed Type Gastic Volvulus And Its Laparoscopic Management

Although gastric volvulus is a rarely occurring and life-threatening entity, it is difficult to diagnose. As this disease may progress with non-specific abdominal symptoms, its diagnosis may be delayed or overlooked. It should be kept in mind in the differential diagnosis of the patients presenting with complaints of epigastric pain, retching, vomiting and weight loss accompanied by distension. Of the radiological imaging modalities, chest x-ray and thoracoabdominal computerized tomography may be useful for the diagnosis. Right now accepted modes of treatment for gastric volvulus secondary to paraesophageal hernia are minimally invasive techniques. In the present article, we aimed to present a 65year-old male with mixed type gastric volvulus, a quite rare type of volvulus.