Osman Doğru

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.

Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease.

PURPOSE: Recurrence after surgery for pilonidal disease remains a challenge. We investigated the application of crystallized phenol as a nonoperative treatment for patients with recurrent, previously operated pilonidal disease. METHODS: Participants were patients treated for recurrent pilonidal disease at our clinics from January 1995 through August 2007. Crystallized phenol was administered on an outpatient basis. Patient and disease characteristics including age, gender, body mass index, occupation, family history, time from previous operation to recurrence and to phenol treatment, number and type of previous operations, and characteristics of recurrent sinuses at entry were prospectively recorded. Outcome variables included number of phenol applications, recovery time, recurrence, and treatment success or failure. RESULTS: A total of 36 patients with recurrent pilonidal disease were treated with crystallized phenol (mean recurrence time after previous surgery, 16.2 ± 4.6 months; number of previous operations, 1.47 ± 0.9). The mean number of phenol applications per patient was 3.7 ± 1.3 (range, 1-7). No serious side effects were observed. Exfoliation of a 2-cm2 area around the sinus openings in 3 patients (8.3%) was easily treated with ointments locally; patients reported minimal pain. Healing was obtained in all patients in a median of 48 (range, 10-153) days. During follow-up (mean duration, 54.4 ± 5.2 months; range, 29-169 months), 31 patients (86.1%) had no recurrence and 5 patients (13.9%) had recurrence. Recurrent sinuses were successfully treated by a second course of crystallized phenol in 2 patients, 1 patient refused retreatment, and healing was not obtained with a second treatment course in 2 patients, yielding an overall success rate of 91.7% and failure rate of 8.3%. CONCLUSION: Crystallized phenol application is a simple, inexpensive nonoperative procedure that can be performed in an outpatient setting and is suitable for the treatment of previously operated recurrent pilonidal disease.

Predictive Value of Procalcitonin for the Diagnosis of Bowel Strangulation

Intestinal obstruction is responsible for 3% of admissions to hospital emergency surgical departments, but it is difficult to distinguish simple obstruction from strangulation. Simple criteria for this distinction are sought. In this experimental study, procalcitonin, a known marker of bacterial inflammation, was used to detect strangulation. The predictive value of procalcitonin for small bowel strangulation was evaluated. Thirty male New Zealand rabbits (mean weight: 3.0 kg) were divided into three groups. In the first (control) group, only laparatomy was performed. In the second group, simple obstruction was created by ligating a 10-cm distal ileum segment. In the third group, distal strangulation was created by ligating a 10-cm distal ileum segment with the mesentery. Blood (1 cc) was taken from the right auricular vein of each animal for measuring the procalcitonin level. In both the control group and the simple obstruction group the procalcitonin levels were normal. In the strangulation group, elevation of procalcitonin was detected after 30 minutes, and the elevation was statistically significant at 120th minute compared with the control and simple obstruction groups. In patients with small bowel obstruction, measurement of procalcitonin levels is easy to perform and can be used in the follow-up. A more extensive clinical study is needed to evaluate the accuracy of the test as a marker.

Influence of Some Substances on Bacterial Translocation in the Rat

An experimental study was planned to determine the effect of zinc, levamisole, misoprostol (prostaglandin(1) analog), and melatonin on the bacterial translocation (BT) that develops in rats after major resection of the liver. To this aim, six groups were formed, each consisting of six rats. Except for the control and sham groups, zinc solution 1 ml/day, (prepared in a way to include zinc sulfate equivalent of 5 mg pure zinc/ml) was given to the zinc groups, levamisole 25 mg/kg/day to the levamisole group, misoprostol 200 mg/kg/day to the misoprostol group, and melatonin 20 mg/kg/day to the melatonin group for 3 days before the operation. After the preoperative administration of 10(10) colony-forming units of Escherichia coli to the experimental groups, the abdomen was opened in the sham group, and only the connections around the liver were cut. In the test groups a 70% liver resection was undertaken. Laparotomy was carried out on all the rats 24 hours after the operation; blood samples were obtained for polymerase chain reaction (PCR) analysis and tissue samples from the terminal ileum for histopathologic examination. PCR results for BT were positive for the control and sham groups, with the difference between these two groups not significant (p > 0.05). A statistically significant decrease was found in the BT of all the treatment groups compared to the control group (p <0.05). The histopathologic examination of terminal ileum in the control group revealed that the inflammatory infiltration was significantly less than that in the other groups (p <0.05).

Pneumatosis cystoides intestinalis: a single center experience.

AIM To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI). METHODS The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. RESULTS Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d. CONCLUSION Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

Implementation of a scoring system for assessing difficult cholecystectomies in a single center

PurposeLaparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis, but sometimes conversion to open cholecystectomy (OC) is necessary. The difficulty of LC or the risk of conversion to OC can be predicted by assessing some preoperative variables. We evaluated the efficacy of the “risk score for conversion from laparoscopic to open cholecystectomy” (RSCLO), which was recently developed by Kama et al. (Am J Surg 2001; 181:520), in a single center.MethodsWe recorded the RSCLO values of 571 patients admitted to undergo LC in the Department of General Surgery, Firat University Hospital, between June 2001 and June 2004.ResultsThe mean RSCLO score of 19 patients who needed conversion to OC was significantly higher than that of the patients who underwent successful LC, at 16.2 (range, −9 to 41) vs −5.7 (range, −20 to 25) (P < 0.001). The RSCLO was well correlated with conversion to OC. The sensitivity and specificity rates for RSCLO determining the risk of conversion to OC were 100% and 96%, respectively, and its positive and negative predictive values were 43% and 100%, respectively.ConclusionWe think that RSCLO could be used to define the term “difficult LC” more accurately and assist in selecting the most appropriate operation.

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.

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.

The Possible Contribution Of 129i In The Drinking Water And Food Supply To The Nodular Formation Of Thyroid Tissue

Nodular formation of the thyroid tissue can occur as a result of exposure to radiation. The nodular goiter is a common disease seen in the city of Elazig and its surroundings, in the eastern part of Turkey. A prospective study was conducted in an effort to identify the role of 129I in drinking water supply. Specimens obtained from nodular and normal thyroid tissue during surgery and also water specimens were counted by nuclear spectrometric system. 129I radioactivity in nodular tissue was noted to be higher compared to normal tissue and the difference was statistically significant (p < 0.05). There was no statistically significant difference (p > 0.05) between 129I radioactivity in the water supply and tissue obtained from the patients who have malignant or benign nodular lesions. These results support that the 129I radioactivity level in the water supply is one of the risk factors of the nodular formation of the thyroid tissue in the eastern part of Turkey.