Yavuz Kurt

D-Dimer in the Early Diagnosis of Acute Mesenteric Ischemia Secondary to Arterial Occlusion in Rats

Background: Early diagnosis of mesenteric ischemia can be life saving. The aim of this study is to investigate the time-dependent diagnostic value of plasma D-dimer and other ancillary laboratory evaluations such as creatine phosphokinase, lactic dehydrogenase, aspartate aminotransferase, alanine aminotransferase, amylase, and leukocyte count in an experimental superior mesenteric arterial occlusion (SMA-O) model in rats. Methods: Forty male Wistar-Albino rats were separated into 4 groups: 2-, 4-, 6-, and 12-hour SMA-O groups. After laparotomy, the SMA was identified and ligated for 2, 4, 6 and 12 h in the 4 respective study groups. Blood samples were taken for laboratory tests 2 h after laparotomy in the control group and at the end of the ischemic period in the study groups. Results: The longer the duration of mesenteric ischemia, the higher were the serum D-dimer levels in the study groups, and statistical significance was obtained at 2 h (p = 0.021). Sensitivity, positive predictive value, negative predictive value, and accuracy of the relation were 88.8, 88.8, 100 and 90%, respectively. Leukocyte count was significantly higher than controls after 12 h. No other laboratory parameter correlated positively with the duration of mesenteric ischemia. Conclusion: Serum D-dimer measurements may be a valuable diagnostic parameter in the early diagnosis of mesenteric ischemia.

Missed injuries in military patients with major trauma : Original study

OBJECTIVE The incidence and subsequent outcomes of missed injuries and the primary factors contributing to each missed injury were analyzed. METHODS Records of 709 trauma patients were reviewed between December 2003 and December 2004. Demographic data were compared and analyzed for two patient groups: those with multiple injuries diagnosed in 24 hours and those with multiple injuries diagnosed in >24 hours. RESULTS Fifty-two missed injuries were determined in 34 (4.8%) patients. There were significant differences between the patients with and without delayed diagnoses, including the mean injury severity scores (23 vs. 16.9), morbidity, and mortality (p < 0.05 for all). Among 69 contributing factors identified, 28 (40.6%) were unavoidable and 41 (59.4%) were potentially avoidable. CONCLUSIONS Missed injuries could usually be encountered in the most seriously injured patients, particularly in those with altered levels of consciousness. Missed injuries were mostly avoidable and most were the result of inadequate clinical examination.

Body image and cosmesis after laparoscopic or open appendectomy.

Introduction Minimally invasive techniques, such as laparoscopic appendectomy (LA), are thought to produce better cosmetic results. The aim of this study was to evaluate the body image and cosmesis of patients after both LA and open appendectomy (OA). Patients and Methods Between August 2007 and June 2008, patients who underwent LA or OA with the diagnosis of acute appendicitis were invited to participate in the study by filling out the body image questionnaire. Patients with OA who had the Rockey-Davis incision and LA patients who had the operation by 3 trocars (10-mm infraumbilical, 5-mm suprapubic and additional 10 mm left lower quadrant), were included in the study. Results A total of 38 patients (20 LA, 18 OA) participated in the study. The mean incision size for OA was 3.2 cm (range, 2 to 6 cm), and the mean scores from the body image questionnaire (both body image scale and cosmetic scale) were similar for both groups (P>0.05). No significant complications or changes in self-confidence (preoperative vs. postoperative) were observed in either group (P>0.05). Conclusions To our knowledge, there is no study in the literature that evaluates body image and cosmesis using objective methods for LA. Our results showed that LA has no advantage for body image and cosmesis over OA. Furthermore, prospective studies using different tools with a larger sample size are needed to rationalize the use of laparoscopy for appendectomy.

The survival effect of E-cadherin and catenins in colorectal carcinomas

Aim  The E‐cadherin/catenin complex plays an important role in epithelial tissue architecture. Decreased expression of cell adhesion molecules (E‐cadherin, α‐, β‐ and γ‐catenin) have been reported to correlate with invasive behaviour. The aim of this study was to investigate the relation between the expression of adhesion molecules and clinicopathological characteristics and survival in colorectal carcinoma.

Colonic volvulus associated with Chilaiditi's syndrome: report of a case.

Hepatodiaphragmatic interposition of the intestine, known as Chilaiditi’s syndrome, is a rare and often asymptomatic anomaly, typically found as an incidental radiographic sign. We report a case of Chilaiditi’s syndrome associated with transverse colon volvulus, predisposed by segmental agenesis of the right lobe of the liver. A 45-year-old man presented with a 2-day history of abdominal pain, nausea, vomiting, and constipation. Plain chest X-ray and abdominal computed tomography showed colonic interposition and segmental agenesis of the right lobe of the liver. Laparotomy revealed a clockwise volvulus of the transverse colon associated with interposition and incarceration of the colon through the space of the agenetic segment of the liver. The transverse colon, which was adherent to the agenetic space in the liver and diaphragm, was dissected away and repositioned, and the volvulus was reduced. To our knowledge, this is only the sixth reported case of a colonic volvulus associated with Chilaiditi’s syndrome and the first case associated with segmental agenesis of the right lobe of the liver.

Hospital Experience, Body Image, and Cosmesis After Laparoscopic or Open Splenectomy

Background Laparoscopic splenectomy (LS) is becoming the “gold standard” technique for splenectomy. The aim of this study was to evaluate the hospital experience, body image, and cosmesis after LS or open splenectomy (OS). Methods Patients who underwent LS or OS were invited to fill out questionnaires evaluating their hospital experience, body image, and cosmetic results. A total of 72 patients (34 LS and 38 OS) agreed to participate in the study. Results No significant difference was observed between the groups in terms of age, sex, body mass index, or indication for splenectomy. Mean spleen weight and postoperative complications were slightly higher (P>0.05) and the postoperative hospital stay was significantly longer (P<0.05) in the OS group compared with the LS group. Scores from the modified Body Image, Hospital Experience, and Photo Series Questionnaires were higher (favorable) in the LS group compared with the OS group (P<0.01, P<0.001, and P<0.001, respectively). Conclusions LS is the procedure of choice for most indications of splenectomy, which has comparable or better perioperative outcomes and complication rate as well as the advantages of better body image, cosmesis, and hospital experience compared with OS. Our results presenting improved outcomes with LS will contribute to the widespread application of laparoscopy for splenectomy.

Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients.

We presented 23 patients with necrotizing fasciitis (NF), 15 of whom had uncontrolled diabetes mellitus (DM), for risk factors, clinical signs, laboratory findings and prognosis during the period 1998 and 2006 in Istanbul. A hospital incidence of NF was 14.2/100,000 admissions. Other risk factors were obesity in 9 and recent surgical trauma in 10 patients. The mean age of the patients with DM was higher than that of the patients with non-DM (58.6+/-12.8 vs 43.0+/-17.2 years, p=0.028). The most frequently isolated microorganisms from tissue cultures were Escherichia coli, Klebsiella pneumoniae and Group A streptococci. Of the 23 patients, 9 (39%), of whom 8 had DM, died between 2 and 29 days after admission. The mortality rate and length of hospitalization were longer in diabetic patients than in others (p=0.02 and p=0.286, respectively). The mean blood glucose levels and HbA1C were higher in non-survival group than in survival group (195.6+/-41.5 vs 133.7+/-22.1 and 10.6 vs 7.4) (p=0.04, r=0.39 and p=0.03, r=0.50, respectively). In the univariate analysis, the hospitalization time (r=0.72), white blood cell count (r=0.52) and surgical debridement count (r=0.47) were found to be prognostic risk factors. Our results showed that NF is a very serious life-threatening disorder in especially diabetic patients with bad metabolic control.

Prognostic value of oncoprotein expressions in thyroid papillary carcinoma

The aim of this study was to evaluate the expressions of oncoproteins and to correlate the results with clinicopathologic parameters in papillary thyroid carcinoma (PTC). Papillary thyroid cancer (PTC) is the most common form and accounts for about 80% of all thyroid cancers. Although PTC generally has a good prognosis, some patients suffer from local recurrence and/or distant metastasis. Oncogenes have reported to be related not only in carcinogenesis but also in tumor prognosis, tumor type, differentiation and site of tumor in epithelial malignant tumors such as thyroid, breast, ovarian, and stomach cancer. This study was planned retrospectively and was performed in 87 patients (47 PTC, 40 benign lesions). The data of clinicopathologic parameters and tissue samples were collected from the archives. Sections stained with H&E were evaluated for each case and after confirming the diagnosis of PTC, oncoprotein expressions were determined by immunohistochemical analysis. The differences of oncoprotein expressions in PTC compared with control group were statistically significant. Cyclin D1 and p53 expressions were significantly increased in PTC. The expressions of bcl-2 and c-erbB-2 in PTC were found as increased, but the correlation between these proteins and poor prognostic parameters were not significant. We suggest that increased expressions of cyclin D1 and p53 could be used as prognostic factors in patients with PTC.

The effects of LigaSure on the laparoscopic management of acute appendicitis: "LigaSure assisted laparoscopic appendectomy".

A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first groups dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second groups with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06±14.73 min vs. 59.69±12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.

Pulmonary echinococcosis mimicking multipl lung metastasis of breast cancer: The role of fluoro-deoxy-glucose positron emission tomography

BackgroundEchinococcosis is still a serious problem particularly in endemic areas such as South and Central America, Mediterranean countries, and Russia. Furthermore, hydatid cysts of the lung are often indistinguishable from a variety of other pulmonary lesions such as lung tumorsCase presentationWe herein present a 56 year old woman with breast cancer who presented with bilateral pulmonary nodules due to echinococcosis granulosis that mimicked metastatic breast cancer to the lung.ConclusionDuring the evaluation of the malignancies which could metastasize to the lung, it must be kept in mind that the appearance of bilateral multiple pulmonary masses can also be the sign of a pulmonary echinococcosis especially in endemic areas. FDG-PET with its known high negative predictive value in characterizing indeterminate pulmonary nodules >1 cm is very helpful to characterize this kind of lesions.