Zafer Cantürk

Is minisite cholecystectomy less traumatic? Prospective randomized study comparing minisite and conventional laparoscopic cholecystectomies.

The main objectives of minisite cholecystectomy (MC) are to have smaller incisions, better cosmetic results, less trauma, and a lower morbidity rate. This prospective randomized study compares MC with conventional laparoscopic cholecystectomy (CLC) in terms of surgical trauma and cosmetic results in 44 patients. Conversion from MC to CLC was required in five patients. No conversion to open surgery was needed in the CLC group. The average operating time was slightly longer in the MC group, but the difference was not statistically significant (81 minutes versus 72 minutes, p=0.22). The population characteristics, postoperative respiratory function measurements, pain scores, and analgesic requirements were similar in the two groups. The average score for scar tissue was significantly lower in the MC group (0.73 versus 1.93, p=0.0045). Only the cosmetic results of MC were superior to CLC. This technique could be a feasible alternative procedure in patients seeking better cosmetic results. However, further studies with larger sample sizes are needed to evaluate the postoperative morbidity of MC.RésuméLes objectifs principaux de la cholécystectomie laparoscopique minime (CM) (par mini-trocars) sont de réaliser de plus petites incisions, d’obtenir un meilleur résultat esthétique, de provoquer moins de trauma et d’avoir un taux plus bas de morbidité que la cholécystectomie par laparoscopic classique. Cette étude prospective randomisée a comparé la CM à la cholécystectomie par laparoscopic (CL) traditionnelle en termes de traumatisme chirurgical et de résultat esthétique chez 44 patients. On a du convertir la CM en CL chez cinq patients. Aucune conversion vers la chirurgie ouverte n’a été nécessaire dans le groupe de CL traditionnelle. Le temps moyen d’intervention a été plus long dans le groupe CM mais cette différence n’était pas statistiquement significative (81 min vs. 72 min, p=0.22). Les caractéristiques de la population, les fonctions respiratoires, les scores de la douleur et les besoins en analgésiques étaient similaires dans les deux groupes. Les scores moyens d’évaluation de la cicatrice ont été significativement plus bas dans le groupe CM (0.73 vs. 1.93, p=0.0045). Seuls les résultats esthétiques de la CM étaient supérieurs à la CL. Cette technique pourrait être une alternative valable chez les patients cherchant une amélioration des résultats esthétiques. Cependant, d’autres études avec des échantillons plus larges sont nécessaires pour évaluer la morbidité postopératoire de la CM.ResumenEl propósito principal de la colecistectomía de invasión mínima (CIM) es lograr una cicatriz pequeña, mejor apariencia estética, menos trauma y morbilidad reducida. El présente estudio prospective y aleatorizado compara la CIM con la colecistectomía laparoscópica convencional (CLC) en cuanto a trauma operatorio y resultado estético en 44 pacientes. Se requirió conversión de CIM a CLC en cinco pacientes, pero ninguna CLC tuvo que ser convertida a cirugía abierta. El promedio del tiempo operatorio fue ligeramente más prolongado en la CIM, pero la diferencia no es estadísticamente significativa (81 min versus 72 min, p=0.22). Las características demográficas de los dos grupos eran similares y las determinaciones postoperatorias de función respiratoria, grado de dolor y requerimiento analgésico fueron sensiblemente iguales. El grado de tejido cicatricial fue significatamente menor en el grupo de la CIM (0.73 versus 1.93, p=0.0045). Sólo el resultado estético de la CIM fue superior al de la CLC. Esta técnica podría ser una alternativa factible en pacientes que busquen un mejor resultado estético. Sin embargo, se requieren estudios adicionales y grupos de pacientes más numerosos para evaluar la morbilidad postoperatoria de la CIM.

Imprint cytology in the diagnosis of Helicobacter pylori : Does imprinting damage the biopsy specimen?

OBJECTIVE To investigate the efficacy of imprint cytology in the diagnosis of Helicobacter pylori infection and whether it damages the biopsy specimen for subsequent histologic examination. STUDY DESIGN Two antral biopsies were taken from 76 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. Imprint cytology was made from the first specimen. This specimen was fixed in 10% formalin and sent for histopathologic examination. The second specimen was directly fixed in 10% formalin for routine histopathologic examination without being used for an imprint. The imprint smears were examined by cytopathologists. The biopsy specimens were examined by pathologists who did not know which specimens were used for the imprints. RESULTS H pylori was seen in smears from 55 (72%) patients and in both biopsy specimens from the same patients. The pathologists could not recognize the biopsy specimens from which the imprints were made. Concordance between imprint cytology and histopathology was 100%. CONCLUSION Imprint cytology is a suitable test for H pylori diagnosis, and imprints do not adversely affect the quality of the biopsy specimen.

Necessity for additional incisions with the cervical Collar incision to remove retrosternal goiters

PurposeRetrosternal goiters (RSGs) can be removed transcervically, but additional incisions are sometimes necessary. We examined the factors determining the need for additional incisions to remove an RSG goiter, based on our experience and on an algorithm.MethodsAmong 499 patients who underwent surgery for a goiter, 52 (10.4%) had an RSG removed via a collar incision. Additional incisions were necessary in 11 patients (21% of those with an RSG and 2.2% overall): a partial sternotomy in 4, total sternotomy in 5, and right thoracotomy in 2.ResultsRecurrent nerve paralysis developed in two patients and one patient had a tracheal laceration. There was no mortality. A diagnosis of adenomatous goiter was confirmed in all patients.ConclusionsAdditional incisions can be made if thyroidectomy cannot be done transcervically and if the goiter extends to the level of the aortic arch. If the thyroid gland extends below the aortic arch and the lateral diameter of the goiter is greater than 10 cm, a partial sternotomy may be required. Total sternotomy is needed when an RSG extends caudally to the azygos vein, if it is located in the retrotracheal or retroesophageal space, or if it is recurrent or ectopic. Coexisting lung disorders and goiters extending to the left atrium also require thoracotomy.

Effect of G-CSF on ethanol-induced hemorrhagic gastritis model in diabetes mellitus-induced rats.

Diabetes mellitus can affect every organ system, including large and small vessels, eyes, nerves, kidneys and gastrointestinal system. Acid peptic disease is an inflammatory condition involving the upper gastrointestinal tract. The elevated serum glucose levels of diabetics affect traditional host defenses such as neutrophil counts and functions. We aimed to investigate changes of gastric mucosa and the role of impaired neutrophil functions in a diabetes-induced experimental model and whether G-CSF, which modulates neutrophil counts and function, has protective effects against gastric mucosal injury in diabetic rats. Fifty rats were divided into three groups. Diabetes mellitus was induced by a single dose of streptozotocin in 40 of 50 rats. Controls had a sham injection. The gastric mucosal lesions were produced by intragastric administration of 1 ml of 95% ethanol in all three groups. Granulocyte colony-stimulating factor (G-CSF) was subcutaneously injected to twenty of diabetes-induced rats. Stomach histology and tissue malondialdehyde and glutathione levels were determined. White blood cell count, neutrophil counts and functions were determined. Peripheral blood cell counts, neutrophil phagocytosis index were decreased but neutrophil adhesivity index was not different in diabetes-induced groups. G-CSF administration improved neutrophil counts and function. Macroscopic and microscopic gastric mucosal injury were significantly greater in control and only diabetes group compared with G-CSF pretreated group (p < 0.05). The tissue malondialdehyde and glutathione levels were significantly decreased in G-CSF-administrated diabetic group compared to untreated diabetics (p < 0.001). Finally, G-CSF has been shown to cause neutrophilia and improve neutrophil phagocytosis in diabetic. G-CSF may be cytoprotective for gastric mucosa in diabetes mellitus-induced rats.