Ömer Topuz

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.

Inhibitory Effects of Sildenafil Citrate on the Tonus of Isolated Dog Internal Anal Sphincter

PURPOSEAlthough the exact pathogenesis of anal fissure is not known, hypertonicity of the internal anal sphincter might be involved in its pathogenesis as main event. To gain information about possible usefulness of the novel, smooth-muscle–relaxing drug, sildenafil, in chronic anal fissure, we investigated the effect of sildenafil citrate on acetylcholine-induced contractility of internal anal sphincter isolated from dogs.METHODSInternal anal sphincter strips were taken from German shepherd dogs and suspended in a tissue bath filled with Krebs solution at 37°C (pH 7.4) continuously bubbled with 95 percent oxygen and 5 percent carbon dioxide, and isometric contractions were recorded. Contractions were evoked by 10 μM acetylcholine, and the effects of different concentrations of sildenafil citrate (0.1, 0.3, and 1 mM) on the isometric tension of each internal anal sphincter strip were examined. The statistical significance was analyzed by one-way analysis of variance.RESULTSPretreatment with sildenafil citrate (0.1 mM) attenuated contractile response to acetylcholine (n = 3), which were significantly weak compared with the maximum contractile response to the acetylcholine alone (610 ± 110 mg vs. 2,825.17 ± 416 mg; n = 12; P < 0.05). Sildenafil citrate also significantly inhibited the acetylcholine-induced contractions in a dose-dependent manner when applied after.CONCLUSIONSThis experimental in vitro study showed that sildenafil citrate relaxes acetylcholine stimulated contractions of isolated dog internal anal sphincter. This may be of importance for raising the possibility that sildenafil cit-rate may have future potential in the treatment of chronic anal fissure. Further studies are needed for a conclusive decision on possible usefulness of sildenafil citrate in patients with chronic anal fissure.

Crystallized Phenol Treatment of Pilonidal Disease Improves Quality of Life

The effects of crystallized phenol treatment of pilonidal sinus on quality of life has not been investigated before. This study aimed to compare the phenol treatment with surgical excision plus primary closure technique in terms of life quality by means of a life quality questionnaire. This is a prospective randomized clinical study. The study was conducted at Training and Teaching Hospital, Kayseri, Turkey. In total, 40 patients with pilonidal disease were randomly assigned into 2 clinically comparable groups between September 2010 and June 2011. Cristallyzed phenol application was done to 20 patients and surgical excision plus primary closure was done to 20 patients for the treatment of pilonidal disease. Data regarding demographic variables were recorded. To evaluate quality of life and patient comfort all patients asked to fill the questionnaire after complete healing occurred. There was no difference between the groups in age, sex and occupation. Two of the 20 patients in the excision and primary closure group had complication of wound dehiscience and needed prolonged wound care. There was significant differences in favor of the phenol group in all terms of life quality except for complete healing time. As a first degree treatment, phenol treatment is better than the other treatment choices of pilonidal disease in terms of time off work perioperative pain, being away from school and social life. Also phenol treatment can be done without any pretreatment laboratory examination. Further studies will be needed about cost-effectivity of phenol treatment.

Effect of melatonin and misoprostol on bacterial translocation in portal hypertensive rats

Background and Aim:  Portal hypertension is the main complication of cirrhosis and it is responsible for its most common complications. Bacterial translocation increases the morbidity and mortality rates in patients with portal hypertension. We aimed to investigate the effects of melatonin and misoprostol on bacterial translocation induced by portal hypertension.

A Rare Cause of Acute Abdomen: Duodenal Perforation of Gastrointestinal Stromal Tumors

Adress for correspondence: Yasemin Cihan, Kayseri Eğitim Ve Araştırma Hastanesi, Radyasyon Onkoloji Bölümü, Türkiye e-mail:cihany@erciyes.edu.tr Available at www.actaoncologicaturcica.com Copyright ©Ankara Onkoloji Hastanesi A Rare Cause of Acute Abdomen: Duodenal Perforation of Gastrointestinal Stromal Tumors Nadir Bir Akut Batın Nedeni: Duodenal Gastrointestinal Stromal Tümör Perforasyonu Yasemin Cihan, Talha Sarigöz, Tamer Ertan, Ömer Topuz, Yusuf Sevim Kayseri Eğitim Ve Araştırma Hastanesi, Radyasyon Onkoloji Bölümü, Türkiye Kayseri Eğitim Ve Araştırma Hastanesi, Genel Cerrahi Anabilim Dalı, Türkiye

Ileoileal intussusception caused by ileal lymphangioma in an adult: A rare case report -

We experienced a case of intussusception caused by ileal lymphangioma in a 26-year-old female who was referred to emergency service with acute abdominal pain. Abdominal ultrasonography and computed tomography revealed ileoileal intussusception. An emergent operation was performed. On histopathologic examination, cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was lymphangioma of the ileum. Al- though intussusceptions due to lymphangioma in an adult are rare, it should be kept in mind that it is a possible diagnosis.

Ileus due to Meckel’s diverticulum: case reports

Meckels diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckels diverticulum.

The Role of the Surgeon in Multidisciplinary Approach to Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the digestive tract with an estimated annual incidence of 10–20 cases per one million inhabitants (H. Joensuu et al;2002, B. Nilsson, et al; 2005). GISTs probably arise from precursor cells of the interstitial cells of Cajal. Their defining characteristic is a gain-offunction mutation in genes coding for the KIT tyrosine kinase receptor, which is considered the driving force of cell proliferation in this tumour(Y. Shinomura et al;2005) Gastrointestinal stromal tumors usually appear in patients above 50 years of age, whereas the maximum incidence is observed in the 5th and the 6th decade of life. The mean age at the diagnosis is 55–63 years(Tran T et al; 2005). It is very rare in children and affects males and females equally. GIST is mainly a disease of the GI tract, mesentery, and omentum. Most commonly, it originates in the stomach (60%), followed by the small intestine (30%), the colon and rectum (5%), and the oesophagus (5%) (Van Der Zwan SM, et al;2005). Fletcher et al. proposed a classification of aggressive behaviour for GISTs based on their maximum diameter and mitotic rate(C. D. M. Fletcher et al;2002). factors which were both shown to predict recurrence and survival(S. Singer et al;2002, R. P. DeMatteo et al;2000). GIST can present in many ways. Thirty percent are diagnosed incidentally on a pathological or autopsy resection specimen(B. Nilsson, et al; 2005). Small tumors may be asymptomatic and GISTs can grow to a large size before producing any symptoms. Most symptomatic patients present with tumours larger than 5 cm in maximal dimension. Symptoms at presentation may include abdominal pain, abdominal mass, nausea, vomiting, anorexia, and weight loss. The vast majority of metastatic GISTs are located intraabdominal, either in the liver, in the omentum, or in the peritoneal cavity(C. D. M. Fletcher et al;2002). Metastatic spread to lymph nodes and to other regions via lymphatics is very rare. Most of the patients with GIST are symptomatic and bleding due to mucosal ulceration is the most common symptom(Gold JS et al ; 2006). Mitotic count and tumor size have been shown to be very important. A large study examined 1765 tumors for prognostic markers(Miettinen et al; 2005 ). Tumours less than 10 cm with less than 5