Sinan Hatipoglu

Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.

Acute right lower abdominal pain in women of reproductive age:Clinical clues

AIM To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age. METHODS Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated. RESULTS Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsings sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies. CONCLUSION Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis.

A rare case of adverse effects caused by leech bite

Patient: Female, 42 Final Diagnosis: Leech bite Symptoms: - Medication: - Clinical Procedure: - Specialty: Infectious diseases. OBJECTIVE Unusual clinical course. BACKGROUND Hirudo medicinalis (H. Medicinalis), also referred to as the medical leech, not only has been used by alternative medicine since ancient times, but it has also been used in modern medical care in the last century. This report introduces and discusses some rare complications from leech bite, beyond external skin hemorrhage. CASE REPORT A 42-year-old woman was referred to our emergency room with painful and itchy lesions on her feet and legs. Because of her knee and leg pain, about 14 leeches were adhered onto both her legs. There were left rubor, tumor and some other areas of itching on leech-adhered regions. In physical examination, the right popliteal region and the same leg posterior area lesions were erythematous, edematous, and plaque-like shaped, as well as ecchymotic and hemorrhagic areas at the centre of the lesions. CONCLUSIONS In this article we present the case of a woman referred to our emergency department with skin findings related to a leech bite. We could not find any report about regional subcutaneous hematoma and cutaneous reactions in the literature. H. medicinalis may cause ecchymosis and various skin lesions, not only external skin bleeding. Physicians should keep in mind leech bite in patients with itchy lesions on the calves, knees, and feet.

Protective effects of intravenous anesthetics on kidney tissue in obstructive jaundice

AIM To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice. METHODS There is an increased incidence of postoperative acute renal failure in patients with obstructive jaundice. Thirty-two Wistar-albino rats were randomly divided into four equal groups. Laparatomy was performed on each animal in the four groups and common bile ducts were ligated and severed on day 0. After 7 d, laparotomy was again performed using ketamine, propofol, thiopental, or fentanyl anesthesia whose antioxidative properties are well known in oxidative stress in a rat liver model of obstructive jaundice. After 2 h, the rats were sacrificed. Renal tissue specimens were analyzed for catalase, superoxide dismutase and malondialdehyde enzymes activities. All values are expressed as the mean ± SD. P values less than 0.05 were considered statistically significant. RESULTS All animals survived without complications until the end of the study. Enlargement in the bile duct and obstructive jaundice were observed in all rats. Catalase was found to be significantly lower in the fentanyl group than in the ketamine (P = 0.039), propofol (P = 0.012), and thiopental (P = 0.001) groups. Superoxide dismutase activities were similar in all groups (P > 0.05). Malondialdehyde was found to be significantly lower in the ketamine group than in the propofol (P = 0.028), thiopental (P = 0.002) and fentanyl (P = 0.005) groups. Malondialdehyde was also lower in the fentanyl group than in the thiopental group (P = 0.001). The results showed that obstructive jaundice sensitizes renal tissue to damage under the different anesthetics. CONCLUSION Among the agents tested, ketamine and propofol generated the least amount of oxidative stres on renal tissues in this rat model of obstructive jaundice created by common bile duct ligation. The importance of free radical injury in renal tissue in obstructive jaundice under different intravenous anesthetics during hepatobiliary and liver transplant surgery should be considered for prevention of postoperative acute renal failure.

The Role of Thyroid and Parathyroid Metabolism Disorders in the Etiology of Sudden Onset Dizziness

Background The aim of this study was to evaluate thyroid and parathyroid functions as a cause of sudden onset dizziness (SOD) in patients who were admitted to the Emergency Department (ED). Material/Methods This study was conducted prospectively in 100 patients with sudden onset dizziness (SOD) admitted to the ED. Neurologic, ear-nose-throat, detailed neck examinations, serum calcium levels, thyroid function tests (TFT), and parathormone and thyroid ultrasounds were performed on all patients in our study. Results Thirty-seven (37%) females and 63 (63%) males were included in this study. Four patients (4%) had elevated serum TSH levels, 6 (6%) had decreased serum fT3 levels, 10 (10%) had decreased serum fT4 levels, 2 (2%) had elevated serum fT4 levels, and 2 (2%) had elevated serum parathormone levels. In 4 (4%) patients, the serum calcium levels were lower than normal, and 2 (50%) of these patients had symptomatic hypocalcemia. Thyroid ultrasound examinations showed multinodular goiter in 28 (28%) patients, 2 (2%) patients had thyroiditis, 12 (12%) had an isolated unilateral nodule, and 58 (58%) had normal thyroid tissues. Conclusions We suggest that detailed neck examination, TFT, and thyroid ultrasound examination should be considered in the diagnostic algorithms of SOD to provide rapid diagnosis and proper treatment for a patient in the ED.

Laparoscopic-Assisted Live Donor Nephrectomy: A Comparison of Conventional and Transvaginal Routes for Kidney Extraction

BACKGROUND Laparoscopic approach has become the standard procedure for living donor nephrectomy in many transplant centers. Because the conventional approach results in cosmetic problems and pain during laparoscopic live donor nephrectomy, transvaginal extraction of an intact kidney has been recently introduced as a minimally invasive technique. Here, we aimed to investigate whether transvaginal extraction of an intact kidney during laparoscopic live donor nephrectomy is associated with decreased postoperative pain, nausea and vomiting, and morphine consumption. MATERIAL AND METHODS This prospective data analysis included a total of 27 female donors who underwent laparoscopic removal of a single kidney for living donor nephrectomy through conventional or transvaginal route. Data collected included age, body mass index, ASA scores, histocompatibility, additional medical disorders, peri- and postoperative complications, postoperative pain scores with visual analogue pain scores (VAS), length of postoperative stay, morphine consumption, degree of nausea and vomiting, level of sedation, and pruritus. RESULTS No significant differences between the transvaginal and conventional groups were observed in VAS scores and morphine consumption at postoperative 1, 3, 6, 12, and 24 hours. Although not reaching statistical significance, according to analysis of morphine consumption, there was a trend toward decreasing analgesic requirements in the transvaginal group at postoperative 12 and 24 hours. There were no significant differences between the groups in terms of degree of nausea or vomiting, or length of postoperative hospital stay. CONCLUSIONS We suggest that with a more desirable cosmetic result, transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy (TVNALDN) is a suitable new minimally invasive laparoscopic technique associated with reduced postoperative pain and analgesic requirements in select women.

Pre-operative stool analysis for intestinal parasites and fecal occult blood in patients with acute appendicitis

BACKGROUND Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy. METHODS Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed. RESULTS In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (p<0.001). CONCLUSION Presence of intestinal parasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

Spontaneous regeneration capacity of controlled small bowel perforations: an experimental study in rats.

BACKGROUND Selective observation method has started to replace routine laparotomy application for abdominal penetrating trauma patients after Shaftans selective observation method applied in the 1960s. In this respect, there is a possibility of bowel perforations healing without operations. An experimental model was established in this study in order to clarify this possibility. METHODS Fifty Wistar-Albino rats were divided into five groups, ten in each. While one group served as the control, distal part of the small bowel of the rats in the other four groups was perforated 1, 2, 3, and 4 mm in diameter with appropriate cutters. After a week of observation, test rats were sacrificed and relaparotomy was applied. The test material consisting of the perforated bowel, covering 1 cm of proximal and distal margins, and some peritoneal tissue was taken for histopathological examination. RESULTS Small bowel perforations with a diameter of 2 mm or below healed spontaneously without any operation. Peritonitis intensity increased in direct ratio with perforation diameters. Wall repair capacity of the bowel diminished with increasing perforation diameters. CONCLUSION It was observed that small perforations in the small bowel of rats could be limited by the organism itself without a necessity of any surgical intervention.

Incidence of postdural puncture headache: Two different fine gauge spinal needles of the same diameter

Objective: The aim of this study was to compare two spinal needles with different bevel designs regarding their technical handling capacities and complication rates. Materials and Methods: After the clinical trials Ethics Committee approval and informed consents from the patients, 220 pregnant female patients undergoing elective cesarean delivery under spinal anesthesia were recruited in the study. Patients were divided into two groups as, Group A (n = 110) and Group Q (n = 110); who received spinal anesthesia via 26 gauge (26-G) atraumatic spinal needle (Atraucan® , B. Braun Melsunger, Germany) and via 26-G Quincke spinal needle (Spinocan® , B. Braun Melsunger, Germany), respectively. Procedure duration, puncture attempts and postdural puncture headache (PDPH) incidence were recorded. The costs of the spinal needles were also noted. Results: There were no significant differences between the two groups in spinal puncture attempts and procedure durations. Similarly, incidence, severity, onset time and duration of headache were not found to be significantly different between the two groups. Ten patients (9.2%) in Group A and 11 (10.3%) in Group Q had developed PDPH. Conclusion: Both spinal needles offer good handling characteristics with comparable incidence of PDPH. Taking into account economical factors 26-G Quincke needle may be preferred to 26-G Atraucan® .

T-tube bridging for the management of biliary tree injuries.

Summary Background: Injuries of the biliary tree, which mainly occur as a complication of laparoscopic cholecystectomy, are a potentially life threatening cause of high morbidity and mortality. The reported frequency of biliary injuries after laparoscopic cholecystectomy is from 0.5–0.8%. Such injuries may sometimes become too complicated for surgical repair. Presented here is the case of a patient with a major bile duct injury for whom bile duct continuity was achieved using a T-tube. Case Report: A 53-year-old man, who developed bile duct injury following a laparoscopic cholecystectomy performed in another center for cholelithiasis, was referred to our clinic. A Roux-en-Y hepaticojejunostomy was performed in the early postoperative period. However, ensuing anastomotic leakage prompted undoing of the hepaticojejunostomy followed by placement of a T-tube by which bile duct continuity was achieved. Conclusions: For injuries with tissue loss requiring external drainage, T-tube bridging offers a feasible option in that it provides bile duct continuity with biliary flow into the duodenum, as well as achieving external drainage, thus alleviating the need for further definitive surgery.