Serdar Topaloglu

Antiapoptotic and protective effects of roscovitine on ischemia–reperfusion injury of the rat liver

Objective: This study was designed to investigate the role of apoptosis on liver IR injury and to determine the effects of roscovitine on this process.

Comparison of Bariatric and Non-Bariatric Elective Operations in Morbidly Obese Patients on the Basis of Wound Infection

Background: Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. Methods: A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. Results: Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. Conclusion: Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

The Effects of Bile Duct Obstruction on Liver Volume: An Experimental Study

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group (n = 4) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (P = 0.01). It was increased up to 60% of baseline values 25 days after BDL (P = 0.002). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (P = 0.002). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.

Enhancing Hepatic Microcirculation in Postoperative Hepatic Failure With Intra-arterial Recombinant Tissue Plasminogen Activator Treatment

Postoperative hepatic failure is one of the most severe complications after liver resection. Treatment protocols have varied from medical support to liver transplant. Here, we describe the clinical course of an 18-year-old female patient with postoperative hepatic failure. The combined use of intra-arterial tissue plasminogen activator infusion and concurrent liver support facilities resulted in successful treatment of postoperative hepatic failure. The role of thrombolytic treatment for postoperative hepatic failure may include future placement in routine treatment protocols, as seen in liver transplant.

Synchronous occurrence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in both lobes of the liver

Occurrence of synchronous double primary liver cancer is a very rare condition. A 48-year-old man underwent lateral sectorectomy and tumor resection from segment (S) 7 and S5 for 3 separate liver tumors. Pathological examination revealed intrahepatic cholangiocarcinoma (ICC) in the lateral sector and hepatocellular carcinoma (HCC) in S7 and S5. This report presents the second case in the literature describing the resection of synchronous double cancers of HCC and ICC localized in both lobes of the liver. We also reviewed the clinical and pathological aspects of this coincidental situation.

Obscure Intestinal Bleeding From Ileo-Ovarian Vascular Malformation

G astrointestinal bleeding of obscure origin is a challenging problem. Because the source of hemorrhage frequently is located in the small bowel, it is not easily identified, and laparotomy would be necessary. The most common cause of obscure smallintestinal bleeding is arteriovenous malformations (AVMs). Polypoid-type ileal arteriovenous malformation is extremely uncommon and its occurrence with ileo-ovarian vascular fistula is not reported in the literature. We here present a case of small-intestinal bleeding caused by a polypoid-type ileal arteriovenous malformation that had a vascular connection with the right ovary.