Necdet Ozalp

HISTOACRYL BLUE VERSUS SUTURED LEFT COLONIC ANASTOMOSIS: EXPERIMENTAL STUDY

Background:  Cyanoacrylates have been advocated as a protective seal in colonic anastomosis to prevent leakage. In order to assess the effects of n‐butyl‐2‐cyanoacrylate on left colonic anastomosis it was compared to the sutured anastomosis in the rat.

Staging laparoscopy for gastric cancer.

Surgical resection remains the only potentially curative treatment of patients with gastric cancer. Evaluation of surgery and other treatments depends on accurate staging of the disease. The objective of the study was to compare staging laparoscopy with ultrasonography, endoscopic ultrasound, computed tomography, and histology for serosal infiltration, lymph node metastasis, peritoneal seeding, and hepatic metastasis. Diagnostic laparoscopy was carried out in 48 patients. Prelaparoscopic staging in all cases included upper gastrointestinal endoscopy and biopsies followed by endosonography, ultrasound, and computed tomography. Preoperative combined examination using CT and laparoscopy was superior when compared with each modality alone or the combinations of the other tests. The present study showed that preoperative evaluation of patients with laparoscopy is superior to all other diagnostic tests. We also found that laparoscopy and computed tomography were better in accurately assessing the serosal infiltration, peritoneal seeding, and hepatic metastases, which thus allows the surgeon to choose more effective treatment modality.

Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy.

Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted this study to establish the preoperative and operative factors predisposing to SSI after gastric resection and D2 lymphadenectomy. Data on all patients undergoing gastrectomy and D2 lymphadenectomy within a 2-year period, at a tertiary reference hospital in Turkey, were collected retrospectively. The outcome of interest was a diagnosis of incisional SSI as defined by the Centers for Disease Control and Prevention. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI. We identified 72 patients with SSI after gastrectomy and D2 lymphadenectomy. The median age of the patients was 61 years (range 31–81 years) and 43 were men. Incisional SSI was diagnosed in 15 (20.8%) patients. Of all the preoperative and operative variables measured, an increased patient body mass index was an independent predictor of incisional SSI. An increased incidence of SSI was found in overweight patients, but these infections were transient and not life threatening.

Copeptin is a predictive biomarker of severity in acute pancreatitis

BACKGROUND Acute pancreatitis remains a common intraabdominal disease with a complex pathophysiology. The overall outcome has improved, but specific treatment remains elusive. The challenge is the early identification and treatment of patients who will develop severe acute pancreatitis. Therefore, the aim of the present study is to investigate plasma levels of copeptin in the initial phase of predicted severe acute pancreatitis. METHODS Between August 2008 and December 2011, 57 patients with acute pancreatitis and 30 healthy individuals were included in the study. Four blood samples, for serum copeptin measurement, were taken from each individual in each group. The first measurement was taken from the admission blood sample. The subsequent 3 samples were taken at 12, 24, and 48 hours after the onset of pain. RESULTS Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients. CONCLUSIONS Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients.

Primary echinococcal cyst of the thyroid: Report of a case

A case of primary hydatid disease of the thyroid, a rare location, is presented. The patient was a 50-year-old woman who presented with a neck mass at the thyroid region, which was noticed 2 months before her presentation. Although the clinical impression was of a neoplastic lesion (adenoma or carcinoma), a hydatid cyst was considered intraoperatively and confirmed by a frozen section histology. It was completely removed. No other sites of hydatid disease were found and the patient remained well postoperatively. In patients with a solitary cyst in the thyroid, the possibility of hydatid disease, though rare, should be always kept in mind, because a needle aspiration biopsy is a potentially harmful procedure.

External validation of a US-derived nomogram that predicts individual survival after gastric cancer resection

Dear Sir; Although the incidence of gastric carcinoma is declining in Western Europe, the disease remains the second most common cause of cancer death worldwide. Surgery is the only curative treatment [1, 2]. Kattan et al. established a nomogram derived from 1,039 patients who underwent R0 gastric cancer resection at Memorial Sloan-Kettering Cancer Center, NY. The nomogram combines easily accessible factors: sex, age, tumor location, Lauren histotype, number of histologic positive and negative nodes, as well as depth of invasion, data that should be available in every institution performing gastric cancer surgery [3]. We analyzed the performance of this US-derived nomogram on the patient population from our gastric cancer database by comparing nomogram-predicted 5-year survival with actual survival. Between January 2000 and December 2002, 65 patients had undergone R0 resection for gastric cancer in the Fifth Department of Surgery, Ankara Numune Training and Research Hospital. Depending on the location of the primary lesion, total or distal subtotal gastrectomy was performed. D2 lymphadenectomy was performed on a routine basis. The following prognostic variables were assembled for use in validating the nomogram: age, gender, primary site, Lauren histotype, number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion as defined by the standard nomenclature. Nomogram validation comprised two activities. These are discrimination and calibration. Model discrimination was measured by the area under the receiver–operator characteristic (ROC) curve [4]. Calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test and the corresponding calibration curves [5]. There were 65 eligible patients with all the information available for the nomogram calculation. With a median follow-up of 40 months, 24 of the 65 patients had died of disease. Discrimination of the nomogram was moderate with area under the ROC curve at 0.688 and the nomogram showed poor calibration. For many clinicians, the most important question regarding prognostic scoring systems is: How can they help with individual patient care decisions? Many physicians believe that group statistics do not apply to individuals. Although individual patients have unique characteristics, they also share many common features with other patients, and consideration of these similarities permits us to anticipate the patients’ responses and predict their outcomes. Statistical predictions of outcome produced by prognostic scoring systems or nomograms are apparently at least as accurate as clinical predictions and, in most cases, are more reliable [6]. Performances of the these commonly used disease severity scoring and mortality prediction systems may be effected by the advances in technology and therapeutic strategies, as the system has been described by the differences in the case mix of a specific clinic from an original database and by the differences in admission and discharge policies between different countries and between different clinics. Even Langenbecks Arch Surg (2009) 394:755–756 DOI 10.1007/s00423-008-0426-z

A rare primary location of echinococcal disease: report of a case.

A case of primary hydatid disease, a rare location, is presented. The patient was a 20 year old female who presented with complaining of painful mass in the right hypochondrium 2 months before presantation. This cyst was strongly adherent to the two layers of m.rectus abdominis fascias. It was completely removed. No other site of hydatid disease was found and the patient remained well postoperatively.

Femoral vessel blood flow dynamics following totally extraperitoneal vs Stoppa procedure in bilateral inguinal hernias

BACKGROUND Both totally extraperitoneal (TEP) and open preperitoneal (Stoppa) procedures involve the placement of prosthetic material preperitoneally. Because the prosthetic material overlies the femoral artery and vein, the aim of this study was to assess its effect on the velocities and diameters of the artery and vein using color Doppler ultrasonography in both approaches. METHODS Sixty-four patients with bilateral groin hernias were prospectively randomized to undergo either TEP (n = 32) or Stoppa (n = 32) repair. All patients underwent color Doppler ultrasound 6 months after the procedures, and the median follow-up period was 18 months. RESULTS Neither mean diameter nor mean flow velocity was changed by the insertion of the mesh preperitoneally. The only change was observed in peak systolic femoral arterial blood velocity, which was significantly decreased in the Stoppa group. Also, no patient in this study developed clinically significant deep venous thrombosis during 6 months of follow-up. CONCLUSIONS The insertion of a prosthetic mesh during TEP and Stoppa procedures does not influence the mean peak flow velocities and cross-sectional areas of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.

Lymphoscintigraphy in detection of the regional lymph node involvement in gastric cancer

INTRODUCTION Involvement of regional lymph node is a critical sign in prognosis of gastric cancer. Radiological techniques are commonly used to evaluate the extension of gastric cancer. But their sensitivity and specificity are low especially in the early stage. Our aim was to assess the value of gastric lymphoscintigraphy in identifying regional lymph node involvement in patients with gastric cancer, as compared to the abdominal ultrasonography, computed tomography and postoperative histopathological evaluation. PATIENTS AND METHODS 50 patients (12 females) with a median age of 61 years (range, 35-73 years) were included in the study. Pre-operative staging in all cases included upper gastrointestinal endoscopy and biopsy, followed by ultrasound, computed tomography and lymphoscintigraphy. 148 MBq Technetium-99m lymphoscint was injected around the tumour during endoscopy and immediately after injection, anterior, lateral and posterior images were taken in 5-min intervals using a gamma camera. Findings were compared to the findings of other tests. The sensitivity, specificity, positive predictive value, and negative predictive value of each test were calculated and compared. RESULTS Histologically, 68% of cases (34/50) had metastasis in regional lymph nodes and all cases were accurately diagnosed by lymphoscintigraphy. Lymphoscintigraphy was significantly more sensitive for detecting lymph node involvement (P < 0.01). Both abdominal ultrasonography and CT had very low sensitivity in identifying lymph nodes. CONCLUSIONS Lymphoscintigraphy is a promising test in the identification of regional lymph nodes pre-operatively in patients with gastric cancer. It might help the surgeon to plan the extent of dissection before surgery which may decrease postoperative complications related to unnecessary extensive lymph node dissection.

A Solid Pseudopapillary Tumour Arising from Mesocolon without Ectopic Pancreas

A solid pseudopapillary tumour (SPT) is an uncommon pancreatic tumour. Very rarely it has also been described outside the pancreas, usually arising from heterotopic pancreatic tissue. In this paper, we described a case arising from the transverse mesocolon without heterotopic pancreatic tissue in an 18-year-old girl.