Onur Birsen

[Four Hydatid Cysts in One Family: Is Family Screening Necessary?].

Hydatid cyst is a parasitic infection mostly caused by Echinococcus granulosus. As transmission occurs from infected dogs, it is endemic in animal husbandry regions. Here four patients within the same family are presented. The first patient is a 10 year-old girl admitted with nausea, vomiting, and fever. On her physical examination, there were decreased respiratory sounds in the right lung, rales, and hepatomegaly. In the radiological examination, cysts were seen in both her lung and liver. After the confirmation of the diagnosis with a serological examination, surgical resection was performed, and albendazole treatment was given. On family screening, cysts were detected in the liver and spleen in her asymptomatic 6-year-old brother; in the lung, liver, spleen, and right kidney in her 33-year-old mother who had repeating abdominal pain; and in the liver and left kidney in her 33-year-old asymptomatic father. Hydatid cyst infection was serologically confirmed in all patients, and they were given albendazole and were surgically treated. In this case report, four patients in the same family and diagnosed as having hydatid cysts were presented. It was emphasized that once a hydatid cyst was diagnosed, family screening became important, in endemic regions in particular.

The analysis of scoring systems predicting mortality in geriatric emergency abdominal surgery.

BACKGROUND Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients. METHODS A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odds ratio were calculated to predict the mortality for these scoring systems. RESULTS The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis. CONCLUSION According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.

Effects of abdominal and vaginal hysterectomy on anorectal functions along with quality of life of the patient

Objectives and background Hysterectomy is the most commonly performed major gynecological operation for both benign and malign gynecologic conditions. After hysterectomy, although some investigators have declared an increased incidence of urinary and anorectal dysfunction, some others could not show any connection. Methods The voluntary patients were divided in two groups: abdominal hysterectomy (Group 1) and vaginal hysterectomy (Group 2). Anal manometry and all the other examinations of the patients were performed at the Department of General Surgery Endoscopy Unit of Ankara University, Faculty of Medicine. Results When the quality of life of the patients was assessed before the operation and on the 12th post-operative month via the SF-36 form; it can be seen that body pain parameters of the patients in Group 1 had significantly improved and there is no statistical difference in other parameters. When the effect of hysterectomy on the quality of life of the patients was evaluated by the “Cleveland Clinic Global Quality of Life” form, the statistically significant improvement in the quality of life of the patients in Group 2 was observed. Conclusion If the type of operation (vaginal or abdominal) is performed due to benign causes, it does not affect the urinary and anorectal functions of the patients. Depending on the decrease of complaints of the patients, it has a positive effect on the quality of life.

Acute renal artery thrombosis after kidney transplantation

Early kidney transplant loss as a result of acute thrombosis of the renal artery remains a constant and devastating complication, with an incidence of 0.2-7.5%. While uncommon, arterial obstruction in the early postoperative period is a surgical emergency and must be ruled out if previously established diuresis ceases suddenly. Arterial thrombosis may occur as a result of injury to a diseased artery, problems with anastomoses, hypercoagulability or malpositioning of the allograft. In this study, we analyzed data on a group of 105 renal transplant recipients who presented with acute postoperative graft dysfunction between January 2006 and May 2012, to identify cases of acute renal artery thrombosis. We report on our experience of immediate re-transplantation following early kidney transplant thrombosis. Overall, two (1.9%) patients suffered early (within 48 hours of surgery) allograft renal artery thrombosis. In both patients, transplantation had not been complicated by atherosclerotic lesions or other thrombophilic states and postoperative diuresis had been successfully achieved, but diuresis ceased abruptly during the early postoperative period. Emergent duplex ultrasound scans were performed and acute renal artery thrombosis was detected in both patients. The patients were operated immediately and retransplantation procedures were conducted. We have reported our experience of immediate retransplantation following early primary graft dysfunction due to renal artery thrombosis. In conclusion, close monitoring of postoperative diuresis and, if necessary, immediate retransplantation in this situation can prove to be a successful treatment for preventing graft loss.

Management of iatrogenic perforations during colonoscopy.

OZET Amac: Kolon perforasyonu, rutin ya da tedavi amacl› yap›lan kolonoskopinin en korkulan komplikasyonlar›ndan biri haline gelmifltir. Bu komplikasyonun tedavisi takip s›ras›nda hastan›n durumuna ba¤l›d›r. Tedavi ac›k ya da laparoskopik acil cerrahi olabilece¤i gibi, konservatif de olabilir. Kolonoskopi s›ras›nda rektal retrofleksiyonun yaralanmas›n da genellikle perforasyon riski dufluktur ve yine bu hastalar›n tedavisi operasyon gerektirmeyebilir. Biz bu yaz›da, elektif kolonoskopi s›ras›nda meydana gelen kolon perforasyonu geliflen hastalar›m›z› ve tedavi yontemlerini sunduk. Hastalar ve Yontemler: Aral›k 2005 ile Aral›k 2010 aras›nda kolonoskopi yap›lm›fl hastalardan perforasyon geliflen hastalara ait bilgiler retrospektif olarak de¤erlendirildi. Bulgular: Yukar›daki tarihler aras›nda 5825 hastaya kolonoskopi yap›lm›fl, 3 hastada perforasyon ABSTRACT Purpose: Perforation of colon has become one of the most fearsome complications of routine or therapeutic colonoscopy. The treatment is immediate surgery via open or laparoscopic technique. However, rectal retroflexion injury during colonoscopy is associated with a low rate of perforation and the cases can be managed non-operatively. We report our series of colonic perforation due to elective colonoscopy and management of the cases. Patients and Methods: Iatrogenic perforation of the colon due to colonoscopy were collected retrospectively at our unit between dates December 2005 December 2010. Results: Of the 5825 colonoscopies performed between the above mentioned dates, a perforation rate of 0.051% was observed and three perforations occurred. Conclusion: Each treatment has to be individualized