Ugur Kesici

Effects of Levobupivacaine on Wound Healing

BACKGROUND:Local anesthetic infiltration along the incision may be used to provide surgical anesthesia or postoperative analgesia. However, the effect of local anesthetics on wound healing remains controversial. In this investigation, we evaluated the effects of levobupivacaine on wound healing. METHODS:Sixty Wistar albino female rats weighing 230 ± 20 g were included, with 10 rats in each group: group early c (early control): 3 mL isotonic saline; group early l1.25 (early levobupivacaine 1.25): 1.25 mg/kg per 3 mL levobupivacaine; group early l2.5 (early levobupivacaine 2.5): 2.5 mg/kg per 3 mL levobupivacaine; group late c (late control): 3 mL isotonic saline; group late l1.25 (late levobupivacaine 1.25): 1.25 mg/kg per 3 mL levobupivacaine; and group late l2.5 (late levobupivacaine 2.5): 2.5 mg/kg per 3 mL levobupivacaine. Rats in groups early c to early l2.5 were euthanized on the 8th day. Rats in groups late c to late l2.5 were euthanized on the 21st day. Wound tension strength, tissue hydroxyproline, and fibrotic index levels of the tissue samples from the early c and early l2.5 and late c and late l2.5 groups, respectively, on the 8th and 21st days were examined. RESULTS:Levobupivacaine decreased wound tension strength on the 8th day, especially a 2.5 mg/kg dose (P < 0.001), and increased it on the 21st day (P < 0.001). It also increased the inflammatory response (P < 0.001) and collagen synthesis (8th day, P = 0.109; 21st day, P = 0.103) on both the 8th and 21st days. CONCLUSIONS:While levobupivacaine had a positive effect on wound healing during the early period, negative effects were observed thereafter. Additional studies at the molecular level are necessary to determine the cause of these apparently opposite effects.

Retrorectal/Presacral Epidermoid Cyst: Report of A Case

Although epidermal cysts are frequently observed throughout the body, they are rarely found in the retrorectal/presacral regions. Retrorectal epidermal cysts are congenital lesions of ectodermal origin and generally occur in women during the reproductive period. In this case report, a 47 year old female patient with 25 years of complaint of a mass extending from the perianal region to the retro-coccygeal region is discussed. A total mass excision with paracoccygeal incision was performed under spinal anesthesia. The histopathologic examination demonstrated an epidermal cyst. Correct diagnosis and appropriate treatment when first detected significantly decrease the recurrence and complication risks in all retrorectal tumors. Any mass should be completely removed in the treatment.

A Case of Traumatic Asphyxia due to Motorcycle Accident

Background. Perthes syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Case Report. In this case report a 36-years-old male patient brought to the emergency room due to thorax trauma related to motorcycle accident was discussed. Distinct cyanotic, edematous, and multiple petechiae were present on the face, neck, and upper thorax regions of the patient. Bilateral subconjunctival hemorrhage was determined. Conclusion. Treatment for traumatic asphyxia is supportive and patient recovery is related to the generally associated injuries. Prognosis of the patients is quite good with effective and timely treatment.

Primary Cyst Hydatid in the Neck; Report of One Case

Hydatid cyst is a parasitic disease that has been recognized endemically in many countries. Although the liver and lung are the most common organs involved by the disease, it may appear rarely in other tissues as a primary disease. In the ultrasonography of the neck taken from a 17 year old case who attended with a complaint of swelling in the neck, a partly regular, bounded cystic lesion of 33x28 mm in size was reported. When the cyst was thought to be hydatid during surgical exploration, this diagnosis was confirmed by histopathological verification of the specimen obtained. Whole abdomen ultrasonography and PA Chest Radiography were taken in order to determine whether there was another focus during the postoperative period. The Echinococcus ELISA test was performed as an immunological parameter. Treatment with Albendazole began after diagnosis during the postoperative period. Although hydatid cyst most commonly involves the liver and lung, it may be detected in all body tissues. Therefore hydatid cyst must be considered in the differential diagnosis in cystic lesions that are rarely encountered in body localizations in human, living in endemic regions.

Effects of glutamine on wound healing.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

Efeitos dos anestésicos locais na cicatrização de feridas

INTRODUCTION Local anesthetic infiltration is used widely for post-operative analgesia in many situations. However the effects of local anesthetics on wound healing are not demonstrated clearly. This study planned to evaluate the effects of lidocaine, prilocaine, bupivacaine and levobupivacaine on wound healing, primarily on wound tensile strength and on collagen ultrastructure. METHODS This study was conducted on male Sprague Dawley rats. On days 0, 8th, 15th, and 21st, all animals were weighed and received a preincisional subcutaneous infiltration of 3mL of a solution according the group. Control saline (C), lidocaine (L) 7mg.kg-1, prilocaine (P) 2mg.kg-1, bupivacaine (B) 2mg.kg-1 and levobupivacaine (LVB) 2.5mg.kg-1. The infiltrations were done at the back region 1.5cm where incision would be performed at the upper, middle and lower part along the midline, under general anesthesia. Wound tensile strengths were measured after 0.7cm×2cm of cutaneous and subcutaneous tissue samples were obtained vertical to incision from infiltrated regions. Tissue samples were also obtained for electron microscopic examination. Evaluations were on the 8th, 15th and 21st days after infiltration. RESULTS There was no difference between groups in the weights of the rats at the 0th, 8th, 15th and 21st days. The collagen maturation was no statistically different between groups at the 8th and 15th days. The maturation scores of the B and L groups at the 21st day was significantly lower than the Group C (1.40, 1.64 and 3.56; respectively). The wound tensile strength was no statistically different between groups at the 8th and 15th days but at the 21st day the Groups B and LVB had significantly lower value than Group C (5.42, 5.54 and 6.75; respectively). CONCLUSION Lidocaine and prilocaine do not affect wound healing and, bupivacaine and levobupivacaine affect negatively especially at the late period.

Agenesis of the isthmus of the thyroid gland

The thyroid is an endocrine gland composed of two lobes connected by the isthmus tissue. Thyroid isthmus agenesis is a rare condition, and only a few cases have been reported in the literature. Here, we discuss the case of a 56-year-old female patient in whom agenesis of the thyroid isthmus was discovered incidentally during surgery for a multinodular goitre. When agenesis of the isthmus is found, associated thyroid lobe agenesis and the presence of ectopic thyroid tissue must be considered. In addition, associated autoimmune thyroid nodule, thyroiditis, primary thyroid carcinoma, metastasis, and amyloidosis must be considered in the differential diagnosis. Preoperative awareness of potential agenesis of the isthmus and its associated thyroid anomalies in patients with planned thyroid surgery will significantly contribute to safety during surgical procedures and result in fewer surgery-related complications.

Morgagni hernia detected due to pneumothorax development during diagnostic colonoscopy

Colonoscopy is used worldwide for the diagnosis and treatment of colorectal disease (1). Intestinal perforation related to colonoscopy is reported as 0.2%-2% (1,2). Although pneumothorax cases related to colon perforation during colonoscopy are reported in the literature (1,3,4), no pneumothorax case related to perforation of a colon segment strangulated due to Morgagni hernia defect has been encountered.