Yilmaz Bilsel

Venous Thromboembolism Prophylaxis after Head and Spinal Trauma: Intermittent Pneumatic Compression Devices Versus Low Molecular Weight Heparin

Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups (p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients.

Abdominal Wall Endometrioma; A 10-Year Experience and Brief Review of the Literature

BACKGROUND Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of Cesarean section or hysterectomy. Certain factors relating to knowledge of the clinical pattern of this disease make correct diagnosis and treatment difficult. The aim was to identify the different forms of presentation of this disease entity through publishing the results from our experience of surgical management of such lesions. METHODS Patients diagnosed with abdominal wall endometrioma over a period of 10 y were identified from the comprehensive surgical database of our institution. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, current operation, and recurrences were surveyed and analyzed. RESULTS There were 40 patients with a mean age of 32.3 ± 5.2 y. All of the patients (100%, n = 40) had an abdominal mass in or adjacent to surgical scars. The main symptom was pain, noncyclic (45%, n =18), or cyclic (40%, n = 16) in nature. The mean duration of symptoms was 18.2 ± 23.4 mo. The preoperative diagnosis was correct in 47.5% (n = 19) of the cases. Surgical treatment failed in 3 cases (3/33, 9.1%), and the operations were performed once again. CONCLUSIONS Abdominal wall endometriosis may be difficult to diagnose as it is comparatively an unfamiliar entity that has not received its due attention among general surgeons, so far. Therefore, in patients with a palpable subcutaneous mass in or around surgical scars with a history of violation of uterus, a thorough history and physical examination is necessary, and usually sufficient to make correct diagnosis of endometrioma.

Endoscopic diagnosis and management of complications following surgery for gallstones.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly being performed for therapeutic purposes. This report reviews our experience in an attempt to determine the role and efficacy of ERCP in the management of postoperative complications following surgery for gallstones. Methods: This study analyzes ERCP records of 418 patients performed in a single referral center after a surgery for gallstones, in the period from December 1991 to June 2000. Results: A total of 451 endoscopic procedures were performed for 418 patients. The primary operations which required ERCP and were included in the study were laparoscopic cholecystectomy (n = 161, 38.5%), choledocholithotomy and T-tube drainage (n = 157, 37.5%), open cholecystectomy (n = 82, 19.6%), choledochoduodenostomy (n = 14, 3.3%), and cholecystostomy (n = 4, 1%). Procedure was carried out successfully in 403 patients (96.4%), whereas a proper endoscopic diagnosis was not achieved in 15 (3.5%). Retained biliary stones (without any associated abnormality) were found in 163 (38.9%), ductal injuries in 44 (10.5%), biliary strictures in 21 (5.0%), papillary stenosis in 36 (8.6%), cystic stump leak (with or without retained stones) in 30 (7.1%), leak from T-tube tract (with/or without retained stones) in 20 (4.8%), and unsuspected malignancies in 18 (4.3%). A sole diagnostic cholangiography was obtained in 63 patients (15.0%). Patients were managed by debris or stone extraction in 169 (40.4%), endoscopic sphincterotomy (ES) in 145 patients (34.6%), stent insertion in 19 (4.5%), or dilatation in 2 (0.4%). Overall successful stone removal rate was 97.4%. Thirty-nine patients with normal cholangiographic findings underwent ES for the relief of presenting signs and symptoms. ERCP-related morbidity was 13.6%. Conclusions: The need for ERCP is rising, especially for stones retained after cholecystectomies. Endoscopy offers safe and effective methods in the treatment of bile leaks, unless associated with major ductal injuries. ES is a reasonable method for treating papillary stenosis and some post-cholecystectomy pain or symptoms.

Traumatic subclavian and axillary vessel injuries

In an analysis of medical records on upper limb vascular trauma over a 9-year period (1989–1997) at Istanbul Faculty of Medicines Surgical and Medical Emergencies Department, it was found that 28 patients required surgery for subclavian or axillary vessel injuries. Of these, 20 cases (71.4%) were the result of penetrating and 8 cases (28.5%) were the result of blunt injury. Eight patients had an associated brachial plexus lesion. Patients were treated by either primary repair (50%), saphenous vein graft interposition (41.6%), or ligation (14.2%). Overall mortality rate was 14% (four cases). No long-term vascular sequela occurred related to the vascular repair techniques. However, the long-term outcome of brachial plexus lesions was poor in four patients. Therefore, the outcome of upper limb injury is not dependent on the vascular injury which can be successfully managed. The long-term consequences are determined by the associated orthopedic, soft tissue, and nerve injuries.

COMPARISON OF SODIUM PHOSPHATE, POLYETHYLENE GLYCOL AND SENNA SOLUTIONS IN BOWEL PREPARATION: A PROSPECTIVE, RANDOMIZED CONTROLLED CLINICAL STUDY

Background:  Low volume oral solutions for colon cleansing before colonoscopy are gaining popularity over large volume oral lavage solutions. Therefore, we aimed to compare three oral solutions for colonoscopy to determine any changes in either patient compliance or cleansing ability.

The Effects of Beta-Aminopropionitrile on Colonic Anastomosis in Rats

Wound contraction is a clinically important biological process because it frequently results in contractures, strictures, and stenosis. If collagen synthesis could be altered to minimize the contracture, then the outcome could be improved. Lathyrism produces poorly cross-linked collagen in healing anastomosis, keeping a larger portion of the synthesized collagen soluble. Ultimately, the amount of contracting collagen is reduced, lowering the bulk and lessening the contracture. The aim of this study was to observe the effects of a lathyrogen, beta-aminopropionitrile (BAPN), on the healing of colonic anastomosis. Thirty rats were divided into three groups. Colostomy and anastomosis were performed on all rats. Intraperitoneal saline solution (control) and either intraperitoneal (ip) or oral (po) BAPN were administered. The rats were killed 1 week later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. Granulation tissue thickness, number of fibroblasts, inflammatory cells, and growing capillaries in granulation tissue per unit area were determined. Collagen fibril diameters were estimated, and spatial arrangements of fibrils were examined by an electron microscope. All results were evaluated by Mann–Whitney U-test. The analyses of anastomotic tissues from BAPN-treated rats showed a significantly reduced mean bursting pressure (158.9 ± 12.3, 171.3 ± 13.9, ip and po, respectively), hydroxyproline content (8.9 ± 2.6, 10.1 ± 2.7), granulation tissue thickness (24.3 ± 2.6, 16.1 ± 5.2), number of inflammatory cells (37.8 ± 4.3, 25 ± 4.3), fibroblasts (3.2 ± 1.1, 2.8 ± 0.7), and a significantly reduced collagen fiber diameter (15 ± 2, 20 ± 3) compared with those of control group (236.9 ± 9, 14 ± 4.4, 26.8 ± 4.8, 39 ± 2.6, 6.9 ± 1.1, and 35 ± 5, respectively). As a result, collagen fibers were flimsy, and lost their regular parallel alignment in the BAPN groups. On the other hand, a number of growing capillaries were found to be significantly increased in these groups (16.5 ± 1.1, 18.2 ± 0.7) compared to the control (6.7 ± 1.3). Thus, it is suggested that BAPN may be useful in the prevention of gastrointestinal stricture formation.

The role of total pericystectomy in hepatic hydatidosis

Between 1977 and 1995, 495 patients were operated on for hepatic hydatidosis. Total pericystectomy was performed in 26 patients (closed technique in 21 and open technique in 5). Twenty-one patients had single cysts and 5 had two cysts. The median cyst diameter was 8cm (range; 3–20cm). The requirements for total pericystectomy were: (1) the cyst(s) should be located away from the hepatic veins, large bile ducts, or major branches of the portal vein and hepatic artery and (2) the patient should be fit to undergo a major operation. There was no procedure-related morbidity. One patient developed a biliary fistula that closed after endoscopic sphincterotomy. The median hospital stay was 7 days (range; 3–22 days). The median follow up was 24 months (range; 9–114 months). There was disease recurrence in a non-adjacent segment in 1 patient at 4 years. Pericystectomy is a potentially dangerous operation, but it avoids problems with cavity management and has low rates of biliary fistula, spillage, and recurrence. Its success stems primarily from careful patient selection.

Evliya Celebi's Description of the Removal of a Musket Ball From the Brain of a Habsburg Prince: An Interesting Excerpt From the ''Seyahatname''

In the 17th century an Ottoman traveler, Evliya Celebi, was inspired by a dream to embark on a journey across the Ottoman Empire. He traveled far and wide across Europe and North Africa and wrote extensively about his adventures in the Seyahatname. The Seyahatname, or “Book of Travels,” is the longest and most detailed travel account in Islamic (if not world) literature. It is a vast panorama of the Ottoman world in the mid-17th century. This article is concerned with Celebi’s description of several surgeries that he claimed to have witnessed in Vienna during the year 1665. He describes several procedures, the first and most detailed of which is a fascinating brain operation that seems to be a highly unusual procedure for the time. His impressions of Central European medicine, as viewed by a Muslim from the East, offer an unexplored perspective. We examine what his description tells us about the perceptions and images of surgery and medicine.

The Impact of Western Physicians on the Modernization of Turkish Surgery and Medicine, 1827–1936

Efforts of modernizing the Ottoman Empire and society started during the 19th century. Initially reforms have been limited by institutions such as the armed forces, faculty of engineering and medicine. For this reason, a large number of western physicians invited to state to take prestigious positions in its few existing medical schools and other state establishments, in particular help with reforming its higher education. After the establishment of young Turkish Republic, western forms of science, medicine, art and literature penetrated the culture and continued to flourish. This article brings to light the efforts of these surgeons, and physicians and tells about their contributions to surgery and medicine in Turkey.