Özer İlkgül

Laparoscopic repair of acquired lumbar hernia.

Lumbar hernias are rare; approximately 300 cases have been described in the literature since their first description. They are typically subdivided by categories such as congenital or acquired and by their location. Acquired lumbar hernias may follow trauma, poliomyelitis, loin incision, and the use of iliac crest as a donor site for bone grafting. Although they tend to grow in size and have a 25% risk of incarceration and 8% risk of strangulation, surgery is indicated once the lesion is confirmed. Many techniques have been described for surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the area. The first laparoscopic repair of lumbar hernia was described in 1996. The laparoscopic approach for lumbar hernia has significant advantages: it enables exact localization of the anatomic defect, the mesh can be placed deep into the defect allowing intraabdominal pressure to hold it in position, and it also has all the well-known advantages of the laparoscopic approach. We present two cases of laparoscopically repaired acquired lumbar hernias.

The effect of recombinant human growth hormone (rhGH) on trinitrobenzene sulfonic acid‐induced colitis in rats. An experimental study

The limited efficacy of standard medical therapies for inflammatory bowel diseases has resulted in a continuing search for alternative treatments. Growth hormone (GH) has shown to have mutagenic and proliferative effects on intestinal cells. This study was designed to identify the effect of growth hormone on trinitrobenzene slfonic acid-induced colitis (TNBSIC) in rats. This study was carried out on 30 rats, divided in 3 groups: group 1: TNBSIC+ GH, group 2: TNBSIC, group 3: saline enema. Colitis was induced in male Sprague-Dawley rats (200 g–250 g) by intracolonic installation of 2, 4, 6-trinitrobenzene sulphonic acid in 50% ethanol. GH treatment has been started and continued throughout the study after inducing colitis. All rats were killed after 5 weeks and colonic segments were examined histopathologically. Microscopic and macroscopic damage scores were caulculated. Intestinal damage scores were found higher in Goups II when compared with treatment group (P < 0.05). There was no damage in group 3 as expected. Both macroscopic and microscopic scores were highest in group 2 (P < 0.05). The myloperoxidase activity was found lower comparing to group 2 (P < 0.05). In conclusion, growth hormone replacement had protective effects against colonic inflammation while reducing intestinal damage on TNB-induced colitis.

Effects of ocreotide on intestinal mucosa in rats with portal hypertensive enteropathy.

To clarify the effects of long-term ocreotide (a long-acting somatostatin analogue) treatment on mucosal changes in a rat model of portal hypertensive enteropathy, groups of male Swiss albino rats (n=15 each) were randomly assigned to one of three treatment arms. These were: sham laparotomy+twice daily subcutaneous saline 0.5 mL (Group 1); portal hypertension induction+twice daily subcutaneous saline 0.5 mL (Group 2); and portal hypertension induction+subcutaneous ocreotide 100 microg/kg/12h (Group 3). After 12 weeks of treatment, jejunal and ileal tissue specimens were obtained and evaluated histopathologically (villus/crypt ratio, mean diameter of dilated vessels, mucosal edema, and fibromuscular proliferation in the lamina propria) and immunohistochemically (vascular endothelial growth factor (VEGF), von Willebrand factor (F8), and cluster of differentiation 34 (CD34) labelling). In jejunal specimens, the villus/crypt ratio was markedly lower in Group 2 (2.38+/-0.46 microm) than in Group 1 (5.07+/-2.25 microm) or Group 3 (4.97+/-2.19 microm); mean diameter of dilated vessels was markedly higher in Group 2 (43.30+/-5.71 microm) than in Group 1 (33.53+/-4.00 microm) or Group 3 (36.76+/-3.96 microm); mucosal edema and fibromuscular proliferation were universally absent in Group 1 when compared with the other groups. There were statistically significant differences (p<0.05) between Groups 1 and 2 for villus/crypt ratio, mean diameter of dilated vessels, VEGF immunolabelling intensity, and CD34 immunolabelling intensity; between Groups 1 and 3 for mean diameter of dilated vessels, VEGF immunolabelling intensity, and CD34 immunolabelling intensity; and between Groups 2 and 3 for villus/crypt ratio, mean diameter of dilated vessels, and VEGF immunolabelling intensity. In ileal tissue specimens, the villus/crypt ratio was markedly lower in Group 2 (5.51+/-0.67 microm) than in either Group 1 (7.19+/-2.18 microm) or Group 3 (7.62+/-2.58 microm); mean diameter of dilated vessels was markedly higher in Group 2 (46.36+/-4.77 microm) than in either Group 1 (36.43+/-4.57 microm) or Group 3 (41.31+/-4.70 microm); while mucosal edema was absent in Group 1, it was present in Group 2 and Group 3; and fibromuscular proliferation was universally absent. There were statistically significant differences (p<0.05) between Groups 1 and 2 for villus/crypt ratio and mean diameter of dilated vessels; between Groups 1 and 3 for mean diameter of dilated vessels; and between Groups 2 and 3 for villus/crypt ratio, mean diameter of dilated vessels, and VEGF immunolabelling intensity. Together, these findings indicate that ocreotide treatment ameliorates histomorphological changes in a rat model of portal hypertensive enteropathy.

The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis.

BACKGROUND The aim of this study was to establish the diagnostic value of leucocyte count and neutrophil percentage in both diagnosing simple appendicitis and predicting complicated appendicitis. METHODS The patients who underwent appendectomy with a clinical diagnosis of acute appendicitis (AA) between January 2011 and December 2012 were studied retrospectively. The data of total WBC count, neutrophil ratio, and physical findings were analyzed. Sensitivities and specificities of leucocyte count and neutrophil ratio were calculated. RESULTS One hundred and fifty-nine patients, diagnosed with acute appendicitis, were operated. Simple appendicitis was detected in 82.4% of the patients and complicated appendicitis in 17.6%. Leucocyte count had low sensitivity and specificity for diagnosing acute appendicitis (67.5% and 36.3%, respectively). Neutrophil ratio had a sensitivity rate of 60.1% and specificity rate of 90.9%. Complicated appendicitis was more common in male patients. Leucocyte count was statistically higher in patients with complicated appendicitis. CONCLUSION Two inflammatory markers, leucocyte count and neutrophil ratio, were evaluated for diagnosing acute appendicitis. Neutrophil ratio had higher sensitivity and specificity for acute appendicitis. On the other hand, increased leucocyte count and male gender was found to be a risk factor for complicated appendicitis.