Omer Faruk Ozkan

Intestinal obstruction due to spontaneous intramural hematoma of the small intestine during warfarin use: a report of two cases.

Warfarin-dependent spontaneous intramural hematoma of the small intestine is a rare complication. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. In some cases, concomitant gastrointestinal bleeding might be seen. Ultrasonography and computed tomography are the most useful radiographic methods for the diagnosis of an intramural hematoma of the intestines. Although it is usually treated conservatively, surgical intervention is required in cases involving active bleeding, intestinal obstruction, or acute abdominal symptoms. Here we present two patients who were treated surgically. Both patients had intestinal obstruction and ischemia, and one had concomitant gastrointestinal bleeding and intussusception due to an intramural hematoma.

Limberg Flap Versus Bascom Cleft Lift Techniques for Sacrococcygeal Pilonidal Sinus: Prospective, Randomized Trial

BackgroundAlthough various methods have been described for surgical treatment of pilonidal sinus disease, which is best is under debate. Tension-free techniques seem to be most ideal. We aimed to evaluate the effects of two tension-free methods in terms of patient satisfaction, postoperative complications, and early recurrence.MethodsA group of 122 patients were prospectively included in the study. Patients were divided into two groups based on the operative method used: Limberg flap or Bascom cleft lift. Quality of life scores, pain scores, length of time for healing, hospital stay, surgical area-related complications, excised tissue weight, and early recurrence information were evaluated.ResultsFollow-up of patients in each group was completed. Patients in the Bascom cleft lift group had shorter operation duration, less excised tissue weight, better bodily pain score, and less role limitation due to physical problems score on postoperative day 10. There was no statistically significant difference between groups for the other criteria.ConclusionsAlthough both techniques provided good results during the early period, the Bascom cleft lift procedure is a reliable technique that provides shorter operation duration and better quality of life during the early postoperative period.

Antioxidant Activity of Syringic Acid Prevents Oxidative Stress in l-arginine–Induced Acute Pancreatitis: An Experimental Study on Rats

The aim of this study was to investigate the possible protective role of antioxidant treatment with syringic acid (SA) on l-arginine-induced acute pancreatitis (AP) using biochemical and histopathologic approaches. A total of 30 rats were divided into 3 groups. The control group received normal saline intraperitoneally. The AP group was induced by 3.2 g/kg body weight l-arginine intraperitoneally, administered twice with an interval of 1 hour between administrations. The AP plus SA group, after having AP induced by 3.2 g/kg body weight l-arginine, was given SA (50 mg kg(-1)) in 2 parts within 24 hours. The rats were killed, and pancreatic tissue was removed and used in biochemical and histopathologic examinations. Compared with the control group, the mean pancreatic tissue total oxidant status level, oxidative stress index, and lipid hydroperoxide levels were significantly increased in the AP group, being 30.97 ± 7.13 (P < 0.05), 1.76 ± 0.34 (P < 0.0001), and 19.18 ± 4.91 (P < 0.01), respectively. However, mean total antioxidant status and sulfhydryl group levels were significantly decreased in the AP group compared with the control group, being 1.765 ± 0.21 (P < 0.0001) and 0.21 ± 0.04 (P < 0.0001), respectively. SA reduces oxidative stress markers and has antioxidant effects. It also augments antioxidant capacity in l-arginine-induced acute toxicity of pancreas in rats.

Fournier's gangrene current approaches †

Fourniers gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fourniers gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi‐Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fourniers gangrene is a safe dressing method. It promotes granulation formation. Flexi‐Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi‐Seal and NPWT) is an effective and comfortable method in the management of Fourniers gangrene in appropriate patients.

The shrinking rates of different meshes placed intraperitoneally: a long-term comparison of the TiMesh, VYPRO II, Sepramesh, and DynaMesh.

Aim The aim of our study was to determine and compare the shrinking rates of different prosthetic materials used in ventral hernia repair and to establish a possible correlation with macroscopic adhesions, histopathologic inflammation, and fibrosis. Methods Thirty-six Wistar albino rats were divided into 4 groups (T, V, S, and D). A midline laparotomy was performed under general anesthesia. A 30×40 mm-sized mesh was placed intraperitoneally and fixed with an interrupted 4/0 polypropylene suture to the anterior abdominal wall. In group T, TiMesh; group V, Vypro II; group S, Sepramesh; and group D, DynaMesh-IPOM were used. All rats were killed at the 90th day postoperatively and the mesh area and the shrinking rate were calculated. Each group was evaluated in correlation with shrinking, adhesion, histopathologic inflammation, and fibrosis, and compared with each other. Results The mean area was 1013.33 mm2 in the T group, 930.44 mm2 in the V group, 1024.44 mm2 in the S group, and 1073.8 mm2 in the D group. The shrinking areas were found as 186.67 mm2, 269.55 mm2, 177.55 mm2, and 126.2 mm2, respectively. The shrinking rates were statistically significant in each group. The lowest shrinking rate was found in group D and highest in group V, but the results were statistically insignificant. In terms of macroscopic adhesion, histopathologic inflammation, and fibrosis no statistically significant differences were found among all the groups in comparison with each other. Conclusions Although the shrinking rate of DynaMesh is lowest among all the groups, the results are statistically insignificant. The results of our experimental study revealed no superiority in the means of mesh shrinkage among TiMesh, Vypro II, Sepramesh, and DynaMesh in the rats.

Combining Flexi‐Seal and negative pressure wound therapy for wound management in Fournier's gangrene

Dear Editors, Fournier’s gangrene is a fast progressing, life-threatening necrotizing infection, which is commonly seen in the dermis and subcutaneous layers of the anogenital region. The infection is usually caused by organisms that spread along the subcutaneous and fascial planes across the perineum, scrotum and often beyond these tissues. The usual treatment is a prompt surgical debridement and, in many cases, a diverting colostomy (1,2). Here, we present a Fournier’s gangrene case, where a combined treatment with the Flexi-Seal Faecal Management System (1) and a negative pressure wound therapy (NPWT) were used to achieve optimal results. Presented case was a 43-year old, female patient, with a body mass index of 38. She was first seen in the emergency unit with a large wound in the gluteal region and high fever. She had been diabetic for at least 5 years. There was also a history of abdominal hernia operation. An extensive necrosis was noted between right gluteal region and labium major. The necrosis was continuing to the femoral canal. The subcutaneous tissues and the deep fascia were also involved. The proximity to anal canal was about 3 cm (Figure 1A). A giant ventral hernia was noted, although we were not sure if it was related to the present problem. The clinical diagnosis of the wound was sepsis associated with Fournier’s gangrene. An immediate surgical debridement was planned and performed. As medical treatment, ceftriaxone and metronidazole were used. At the end of the debridement, a Flexi-Seal Faecal Management System

Iliopsoas haematoma: a rare complication of warfarin therapy.

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach.

An extremely rare complication of Meckel's diverticulum: enterocutaneous fistulization of umbilical hernia.

elements or potentiality for malignant degeneration in the medium term, and the risk of infection in benign cysts. This patient was discharged on the seventh postoperative day, with uneventful recovery. The resection of the coccyx is not recommended unless there is suspicion of involvement by malignant disease3. As far as rectum is often densely adhered to the tumor, should be carried out careful dissection, to avoid injury. There are three types of surgical approach: anterior or abdominal transperitoneal or extra-peritoneal, conventional or laparoscopic access; the posterior approach; and combined abdominosacral route. The anterior approach is used for high lesions (with caudal end until the level S4) without evidence of sacral engagement. The rectum is folded laterally and the median sacral artery is usually linked with the dissection and tumor is enucleated2. The latter approach is preferred for smaller, benign lesions that do not extend beyond the level S4. This route is used when the presence of neural involvement or for better viewing and preservation1. Tumors of major proportions exceeding proximal and distal S4 level are more easily operated via abdominosacral2 route. The resection can be performed synchronously with the patient in the lateral position or sequentially with the change in position after each stage of the operation. The benefit of the combined approach includes the ability to display structures such as ureter, nerve and sacral iliac vessels, particularly important in cases where there is the need to perform partial sacrectomy, especially in chordoma. The adjuvant therapies have only a secondary role in the management of tumors in retrorectal space. In cases where radical surgery is contraindicated, palliative radiotherapy has been carried out, except for chordoma, classically radioresistant. The survival of benign tumors approaches to 100% in most studies7. However relapse is not uncommon. Development of cysts relapses up to 15%1. Approximately 9-45% of retrorectal malignant tumors are most commonly solids than cystic, with recurrence rates of 45%; five year survival rate is about 8 to 17%.

Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats

BACKGROUND L-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine. MATERIALS AND METHODS A total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 × 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 (carnitine study diabetic, n = 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. RESULTS The percentages of viable areas in groups 1-4 were 70.38 ± 6.10%, 62.66 ± 1.55%, 62.59 ± 2.94%, and 73.48 ± 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groups-4 were 23.57 ± 3.27 mg/dL, 21.58 ± 2.35 mg/dL, 22.04 ± 2.71 mg/dL, and 27.11 ± 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG. CONCLUSIONS We demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FN serum might have a role in this process.

Agenesis of Isthmus of the Thyroid Gland in a Patient with Graves-Basedow Disease and a Solitary Nodule

The thyroid is a vascular endocrine gland with two lateral lobes connected by a narrow, median isthmus. Although a wide range of congenital anomalies of the thyroid gland has been reported in the literature, agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. We describe a patient with no isthmus of the thyroid, associated with Graves-Basedow disease. Thyroid isthmus agenesis should be kept in mind in order for surgical procedures involving thyroid pathologies to be carried out safely.