Turgut Piskin

Investigation of a One-Time Phenol Application for Pilonidal Disease

Objective: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. Subjects and Methods: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. Results: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months’ observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10–63 days). There were 4 recurrences after a mean of 14 months’ follow-up and the overall success rate was 70%. Conclusions: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.

Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases

PurposeTraumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is difficult.MethodsForty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated.ResultsThere were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17–69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015).ConclusionThe outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.

Tumescent local anesthesia for excision and flap procedures in treatment of pilonidal disease.

PURPOSE: We describe our experience with tumescent local anesthesia for excision and flap procedures in the treatment of pilonidal disease. METHODS: Forty consecutive patients with symptomatic pilonidal disease were treated. Tumescent solution was prepared by mixing one volume of a lidocaine (20 mg/ml) and adrenaline (0.0125 mg/ml) combination with 9 volumes of lactated Ringers solution. The final solution was infiltrated gradually and liberally, first subcutaneously and then into the skin. The end point was swollen and firm skin. After excision, the area was filled with an advancement flap or a rotational flap. RESULTS: The study group consisted of 37 men (92.5%) and 3 women (7.5%); mean age, 27 (range, 18–61) years. The amount of injected solution ranged from 60 mL to 140 mL (mean, 100 mL; dose interval, 2–4 mg/kg). No additional anesthesia or sedation was needed, and no complications were observed during the procedure. Half of the patients were discharged on the day of the operation, half on the next day. Follow-up ranged from 13 to 37 months. Patients returned to daily activities after a mean of 10.5 (range, 2–30) days. Primary healing occurred uneventfully in 28 patients (70%); wound healing complications occurred in 12 (30%). No flap necrosis was observed. Thirty-seven (92.5%) patients reported satisfaction with the procedure. Recurrence was observed in 3 patients (7.5%). CONCLUSIONS: Excision and flap procedures for sacrococygeal pilonidal disease can be performed under tumescent local infiltration anesthesia with acceptable results, without requiring regional or general anesthesia.

Living Donor Liver Transplantation for Alveolar Echinococcus Is a Difficult Procedure

Surgical resection is the best treatment for early stage alveolar echinococcosis of the liver. In the stages that are not appropriate for resection and when the case develops complications, a liver transplant can be a lifesaver. The liver transplants of alveolar echinococcosis are technically difficult because of prior operation, interventional radiological procedures, and large mass. Despite such difficulty, living donor liver transplantation can save ones life.

Ruptured Hydatid Cysts into the Peritoneum: A Case Series.

Introduction:The rupture of a hydatid cyst into the abdominal cavity is a rare and serious complication.Methods:In this retrospective study, we evaluated ten patients who were surgically treated for ruptured hydatid cysts into the peritoneum at a university hospital in an endemic area between 2003 and 2008.Results:There were three female and seven male patients, with a mean age of 34.2 years (range 20–79). Ruptured cysts were located in the liver (7), pelvis (2), and spleen (1). Eight patients had other nonperforated hydatid cysts. Perforations were spontaneous in seven patients and traumatic in three. Patients’ diagnoses were done with abdominal ultrasound (3), computed tomography (6), and laparotomy (1). The surgical treatment of perforated cysts were radical (pericystectomy) in one patient and conservative (partial pericystectomy) in the other nine patients. There was postoperative morbidity (surgical site infection) in one patient and one postoperative recurrence of disease in another patient. Mortality was seen in one patient 2 months after operation due to pulmonary hydatid cyst and infection.Conclusion:The rupture of hydatid cysts into the peritoneal cavity should be included in the differential diagnosis of acute abdominal pain in endemic areas. Perforation in a young patient may be the first presentation of hydatid cyst. Multiple hydatid cysts may be a predisposing factor for perforation. Location of the cyst on segment VI of the liver may be a predisposing factor as well. Emergency surgery is the main treatment for intraperitoneal rupture of hydatid cysts and medical treatment should be given postoperatively.

Laparoscopic Drainage of Pyogenic Liver Abscess

This study suggests that minimally invasive, laparoscopic techniques be considered for drainage of liver abscess before open exploration is performed.

Perforated Hepatic Hydatid Cyst into the Peritoneum with Mild Symptoms

Rupture into the abdominal cavity is a rare but serious complication of hydatid disease that necessitates emergency surgical intervention. We present herein a case with mild abdominal symptoms due to hydatid cyst rupture into the peritoneum after trauma. A 24-year-old man was admitted to the emergency room with mild abdominal pain. His symptoms had started after a fall four days earlier. Ultrasonography and computed tomography showed cystic lesions in the liver and peritoneum with intraabdominal free fluid. He was treated surgically with partial cystectomy and falciformoplasty. Postoperative albendazole therapy was given for two months. There was not recurrence four months postoperatively at control computed tomography.

Can an extended right lobe be harvested from a donor with Gilbert's syndrome for living-donor liver transplantation? Case report.

Gilberts syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patients selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.

A Rare Cause of Diarrhea in a Kidney Transplant Recipient: Dipylidium caninum.

We report the first case of dipylidiasis in a kidney transplant recipient. Watery diarrhea due to Dipylidium caninum was observed in a male patient who had been undergone kidney transplantation 2 years before. The patient was successfully treated with niclosamide. D. caninum should be considered as an agent of diarrhea in transplant patients.

A kidney transplant center's initial experiences in eastern Turkey.

OBJECTIVES Kidney transplantation is the best treatment method associated with improved quality of life and better survival for patients with end-stage renal disease. We started performing kidney transplantations in November 2010. We have performed 19 kidney transplantations so far. Fourteen of these were from living donors and five from deceased donors. Here, we present our initial experiences with 14 kidney transplant recipients from living donor kidney transplantations. MATERIALS AND METHODS All recipients and their donors underwent detailed clinical history and examination. Recipients and their donors were followed in the transplant clinic during hospitalization. RESULTS The male-to-female ratio was 11:3 in recipients. The mean age of recipients was 27.8 years (range 4-58 years). The number of the related, emotionally related, and unrelated transplantations were 9, 3, 2, respectively. The mean warm ischemic time was 95.7 seconds (range 52-168 seconds). Urine output started immediately after vascular anastomosis in all. The mean time of discharge from hospital was postoperative day 8 (range 4-18 days). The mean flow up was 125 days (range 18-210 days). Graft survival was 100% in this period, but one patient died from sepsis after 56 days. No kidney was lost from rejection, technical causes, infection, or recurrent disease. CONCLUSION If transplant centers are as equipped and experienced as ours, kidney transplant programs should be started immediately so that they can reduce the number of the patients in waiting list for kidney transplantation.