Tahir Özer

Surgical treatment of caustic esophageal strictures in adults

BACKGROUND AND AIMS Caustic esophageal injury is a rare clinical condition in adult patients. Although dilatation, or the conservative approach, is the primary treatment method, some patients require surgical intervention. Because of the rarity of such cases, standard surgical treatment algorithms cannot be utilized. In this article, we present our surgical experience and discuss the challenges in the surgical management of corrosive injury of the esophagus in adults. METHODS A retrospective review was conducted of 28 patients who suffered from a corrosive esophageal injury between 1996 and 2011. Patient demographics, history of corrosive material ingestion, preoperative findings, treatment strategy, operative technique, postoperative course, requirements for further treatment, and the current status of the patients were investigated. RESULTS All patients underwent a transhiatal esophagectomy in addition to a gastric pull-up with a cervical esophagogastrostomy. The mean follow-up time was 62 (12-140) months. One patient developed a deep surgical infection; anastomotic stenosis was noted and treated with dilatation in 13 patients. The mean time period between the operation and the first dilatation for 12 patients was 81 (45-161) days. The mean dilatation count for the patients was 3 (1-10). CONCLUSION Although it comes with high anastomotic stenosis rates, transhiatal esophagectomy and gastric pull-up with cervical anastomosis is a safe procedure, which can be performed for the treatment of corrosive esophageal stricture.

Is Removal of the Stent at the End of 2 Weeks Helpful to Reduce Infectous or Urologic Complications After Renal Transplantation

OBJECTIVE Ureteral stents are used to reduce urologic complications after renal transplantation. However, they predispose to infection. The optimal time to keep them in the urinary tract has not yet been defined. The aim of this study was to evaluate the effect of early removal at the end of 2 weeks on urinary tract infections and early urologic complications (within 3 months), such as ureteroneocyctostomy leakage as well as ureteral anastomosis stricture or obstruction. METHODS We retrospectively analyzed the medical records of 48 patients who underwent renal transplantation using a ureteral stent. The patients were divided into two groups according to the time of stent removal: at the end of 2 weeks (group A; n = 10) versus at a later time (group B; n = 38). RESULTS The urologic complication rate was 0% in group A and the urinary tract infection rate, 2%. The urologic complication rate was 0% in group B and the urinary tract infection rate, 35%. CONCLUSION Early removal of the stent at the end of 2 weeks after renal transplantation is decreased the rate of urinary tract infections.

Can D-dimer become a new diagnostic parameter for acute appendicitis?

INTRODUCTION In this study, we investigated D-dimer serum level as a diagnostic parameter for acute appendicitis. MATERIALS AND METHODS Forty-nine patients were enrolled in the study. Patients were classified according to age; sex; duration between the beginning of pain and referral to a hospital or clinic; Alvarado scores; and in physical examination, presence of muscular defense, the number of leukocytes, preoperative ultrasonography, and D-dimer levels of histopathologic study groups were analyzed. RESULTS Of the patients enrolled in the study, 26.5% were females and 73.5% males. The average age was 21 years (range, 16-38 years) and 81.7% acute appendicitis (AA). According the duration of pain, 63.2% of the patients were referred to the hospital within the first 24 hours, 26.5% of the patients were referred to the hospital within 24 to 48 hours, and 10.3% were referred to the hospital within a period of more than 48 hours. No statistically significant difference was determined regarding D-dimer levels between the histopathologic study groups (P > .05). Alvarado scores lower than 7 were found in 36.7% and 7 or higher in 63.3% of the patients. There was no statistically significant difference related with D-dimer levels between histopathologic study groups (P > .05). The ratio of cases with a number of leukocytes below the upper limit were determined respectively as 32.7% and 67.3%, and no statistically significant difference was found regarding d-dimer levels between histopathologic study groups (P > .05). CONCLUSION Increased D-dimer levels should not be considered as a diagnostic parameter in diagnosis of acute appendicitis.

Do we need to use subcutaneous suture for pilonidal sinus treated with excision and simple primary closure

Abstract Objective : Pilonidal sinus (PS) is a chronic intermittent disease. There are numerous surgical treatment procedures that have been previously reported, yet none have been proved to be ideal. The main issues concerning the surgical treatment of PS are simplicity and cost-effectiveness. This study is designed to research the possibility of decreasing operation costs in the excision and simple primary closure technique of PS by omitting subcutaneous suture usage. Materials and methods : 152 male patients with chronic PS were included in the study. All patients were treated with excision and simple primary closure technique and randomized into two groups. Group-I (n = 74) received subcutaneous closure with 2/0 polyglactin sutures, but Group-II (n = 78) did not. Wound edges were re-approximated by using deep interrupted matress 0 no polypropylene sutures in both groups. Results : In Group-I; overall 7 (9.5%) early complications were noted; 2(2.7%) wounds broke down and 5 (6.7%) experienced superficial wound infections. Any late wound complications were noted. A total of 98 polypropylene and 104 polyglactin sutures were used. In Group-II; overall 5 (6.4%) early wound complications were noted; 3 (3.8%) had wound dehiscence and 2 (2.6%) developed superficial wound infections. Also, 1 (1.3%) late wound complication (wound dehiscence) occurred. Overall 104 polypropylene sutures were used. Conclusion : Excision and simple primary closure is a simple and cost effective surgical procedure in the treatment of PS. Omitting the use of subcutaneous sutures makes the procedure simpler and decreases the operation costs.

Increased damage from rifle wounds of the chest caused by bullets striking commonly carried military equipment

BACKGROUND The purpose of this study was to investigate the fragmentation effect of the bullet that passes through the radio or ammunition magazine, which are essential pieces of equipment for a soldier, in thoracic gunshot injuries. METHODS Twelve adult pigs were used. The pigs were separated into three groups (each group contained four pigs). The first group was shot without any obstacle between muzzle and subject. The second group was shot through a cartridge magazine placed in front of the subjects thoracic cage. The third group was shot with a radio in front of the subjects thoracic cage. RESULTS It was observed that there was a large bullet entrance and fragmentation in the pigs that were shot with a radio or magazine placed over them, and there was no fragmentation in those that were shot without any obstacle. CONCLUSION Metal equipment that soldiers carry causes bullet fragmentation. Fragmented bullets may cause excessive tissue disruption of intrathoracic vital organs.