Comparison of preoperative and postoperative serum thiol/disulfide levels in patients undergoing laparoscopic sleeve gastrectomy for morbid obesity.

OBJECTIVE: Obesity, a prevalent chronic disease, results from an imbalance between energy intake and expenditure. The oxidative stress associated with obesity stems from an imbalance between reactive oxygen species and the cell's antioxidant defense system. Oxidative stress can cause many diseases. The assessment of thiol/disulfide balance, a biochemical test, can be used to detect oxidative stress. The aim of this study is to determine the changes in oxidative stress associated with obesity after obesity surgery by assessing the thiol/disulfide levels. PATIENTS AND METHODS: The study was conducted with 40 volunteer patients with a body mass index (BMI) above 40 who underwent obesity surgery at Harran University Hospital General Surgery. Thiol and disulfide levels and other blood parameters were measured from the preoperative and postoperative 2nd and 6th-month blood samples of the patients. BMI was calculated by recording the weights and heights of the cases. Patients with diseases that could affect oxidative stress measurements and those using medication were excluded from the study, and the analyses were performed accordingly. RESULTS: The results showed a statistically significant decrease in native thiol, disulfide, reduced thiol, oxidized thiol, glucose, ALT (alanine aminotransferase), ALP (alkaline phosphatase), total cholesterol, HDL (high-density lipoprotein), triglyceride, and BMI values between the preoperative, 2-month postoperative, and 6-month postoperative measurements (p<0.05). CONCLUSIONS: Restrictive methods such as sleeve gastrectomy in individuals with morbid obesity led to weight control and a decrease in adipose tissue, reducing oxidative stress and increasing antioxidant response.

Can fibrinogen level be a criterion in choosing the treatment option in patients with acute cholecystitis?

OBJECTIVE: We aimed to investigate whether there is a relationship between blood fibrinogen levels during hospitalization of patients hospitalized for conservative treatment due to acute cholecystitis (AC) in our clinic. Patients underwent surgery and were discharged with medical treatment. PATIENTS AND METHODS: The files of 118 patients who were hospitalized due to the diagnosis of AC and planned for conservative medical treatment in our clinic between January 2018 and February 2020 were recorded, prospectively. The patients were divided into two groups as those who responded to conservative treatment (Group 1), and those who were operated urgently despite conservative treatment (Group 2). Increase in gallbladder wall thickness, presence of pericholecystic fluid and hydrops sac on ultrasound and computed tomography (CT) were considered significant for the diagnosis of acute cholecystitis. Blood fibrinogen levels were measured in all patients during hospitalization. RESULTS: The mean age of 118 patients included in the study was 58.32 (19-96) years. There were 77 patients in Group 1 and 41 patients in Group 2. Serum fibrinogen level was found to be 298.34±111.7 mg/dl in Group 1 and 637±124.5 mg/dl in Group 2, and a statistically significant difference was found (p<0.001). When the cut-off value for the fibrinogen level was taken as 564.50 mg/dl, the sensitivity and specificity of the test were found to be 75.6% and 61%, respectively in showing surgical treatment. CONCLUSIONS: As a result of our study, we concluded that when the data obtained are evaluated, it should be kept in mind that despite medical treatment, there is an urgent need for an operation in patients with acute cholecystitis, and in patients with high plasma fibrinogen level (cut-off) at first admission.

The Alvarado Score is accurate in pregnancy: a retrospective case-control study.

BACKGROUND: Acute appendicitis is the most frequent abdominal condition that requires non-obstetric surgical intervention during pregnancy. This study aims to scan pregnant patients operated on for acute appendicitis to evaluate the efficiency of using the Alvarado Score (AS) for diagnosis. METHODS: Our study included 48 pregnant patients who were pre-diagnosed with acute appendicitis and operated on at our department of general surgery from January 2010 to July 2016 and whose files were accessed. Fifty-three non-pregnant female patients of reproductive age who were operated on for appendicitis during the same period were included in the study as the control group. The patients in both groups were divided into two groups based on their AS total score being 7 and ≥ 7. RESULTS: The mean age of the 48 pregnant patients was 28 (19-42) years, while the mean age of the 53 control patients was 31 (18-45) years. Among pregnant and non-pregnant women, about a third of patients had an AS < 7 (16 of 48 versus 18 of 53). There was no significant difference when the AS scores of both groups were compared (p = 0.947). Using pathology results as reference test, the sensitivity and specificity of the AS in pregnant women was 79 and 80%. CONCLUSIONS: As a result, when the data collected by our study are evaluated, we see that pregnancy does not have a negative effect on the efficacy of AS. Therefore, the AS system can be an easy, non-invasive auxiliary diagnostic tool with high diagnosis accuracy rates that can be used in pregnant patients suspected of having acute appendicitis.

The effects of lycopene on methotrexate-induced liver injury in rats.

BACKGROUND: The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx) induced liver toxicity in rats. METHODS: Twenty-eight male Sprague-Dawley rats were divided into four equal groups: control, Lyc, Mtx and Mtx-L: Control group: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for ten days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were post-treated with Lyc (10 mg/kg) for ten days after a single dose of Mtx (20 mg/kg). RESULTS: Mtx administration increased histopathological damage, TNF-α, IL-1ß, TOS, TAS and OSI levels in tissues; AST, ALT levels in the blood. Sinusoidal dilatation, inflammatory cell infiltration and congestion were significantly improved in the Mtx-L aon histopathologic examination of the rats.In Mtx-L group that were treated at the Lyc, TNF-α and IL-1ß levels of liver tissue were decreased significantly compared to Mtx group whereas the decrease in OSI was not significant. Lyc treatment improved the AST and ALT values in Mtx-L group. But only AST improvement was significant. CONCLUSIONS: The results of this study revealed that Lyc might be useful in protecting the liver from injury due to Mtx in rats by reducing the increased proinflammatory cytokine levels (Tab. 4, Fig. 1, Ref. 44).

The effect of chronic constipation on the development of inguinal herniation.

OBJECTIVE: To investigate the effect of constipation on the development of inguinal herniation and type of herniation using the Constipation severity scale. METHODS: A total of 100 patients who underwent surgical inguinal hernia repair (study group) and 100 healthy volunteers without inguinal herniation (control group) were included in this study. The constipation severity scale was administered to all patients. The type of the herniation was classified using Nyhus scale during surgery and the side of the herniation was recorded on completed questionnaires. The obstructive defecation sub-scale score, colonic inertia sub-scale score, pain sub-scale score, and the total score were recorded for each patient and the association between constipation and the development of inguinal herniation was investigated. RESULTS: The mean age of patients in Group 1 and 2 was 40.92 ± 17.80 and 33.71 ± 9.13, respectively. There was a significant difference between the two groups in terms of obstructive defecation and colonic inertia sub-scale scores (p < 0.01). In addition, except for the pain sub-scale score, there were significant differences between Nyhus hernia types with regard to sub-scale scores of the constipation severity scale in patients in Group 1 (p < 0.01). CONCLUSION: Significantly higher obstructive defecation subscale, colonic inertia subscale, pain subscale, and total scores in the study group as compared to controls shows that constipation may represent an important etiological factor for the development of inguinal herniation.

Does calcium dobesilate protect against intestinal ischemia-reperfusion injury induced in rats?

OBJECTIVE: In this study, we investigated whether the administration of calcium dobesilate (CD) affects oxidative stress markers and histopathological outcomes in a rat model of intestinal ischemia-reperfusion (IR) injury. MATERIALS AND METHODS: This study was conducted with 30 male Wistar rats. The rats were randomly assigned to three groups as follows: a sham group (n = 10), an IR group (n = 10), and an IR + CD group (n = 10). In the sham group, superior mesenteric artery (SMA) dissection alone was performed during laparotomy. In the IR group, the procedure included SMA occlusion for 60 min, followed by reperfusion for 60 min. In the IR + CD group, CD (100 mg/kg/day) was additionally given for two days before laparotomy by intragastric lavage. In all the rats, 2 ml of blood were drawn, and an ileal segment (approximately 2 cm in size) was removed to evaluate oxidative stress markers. The ileal segment removed was divided into two pieces, and one piece was reserved for histopathological evaluation. RESULTS: Compared to the other groups, both serum and tissue oxidative stress indices were lower in the IR + CD group. The decrease was due to CD increasing the total antioxidant capacity. Moreover, the histological analysis showed that CD reduced tissue injury. CONCLUSIONS: CD may exert a protective effect against intestinal IR injury by increasing antioxidant capacity.

Investigation of CTLA-4 and CD28 gene polymorphisms in a group of Turkish patients with colorectal cancer.

Colorectal cancer (CRC), also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. The immune system is an important defence mechanism against cancer and is often dysfunctional in patients with malignancies. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and CD28 genes encode receptors that provide negative and positive signals, respectively. Polymorphisms in these genes can affect their functions. In this study, we aimed to investigate the association of cancer with the frequencies and roles of CTLA-4/+49A > G (exon 1) and -318C > T (promoter), and CD28/IVS3 + 17T > C (intron 3 position + 17). These polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 218 Turkish subjects (56 patients with CRC and 162 healthy controls). No statistically significant differences in the genotype distributions of CTLA-4/+49GG (1.8% vs. 6.8%, odds ratio (OR) = 0.250, P = 0.305) and CTLA-4/-318TT (0% vs. 0.6%, OR = 1.006, P = 1.000), and CD28/IVS3 + 17CC (8.9% vs. 3.7%, OR = 0.2411, P = 0.155) between patients with CRC and healthy controls, were observed. We also found that there were no significant differences in the frequencies of CTLA-4/+49G (18.8% vs. 20.1%, OR = 0.920, P = 0.891) and CTLA-4/-318T (7.1% vs. 4.3%, OR = 1.653, P = 0.314), and CD28/IVS3 + 17C alleles (25.9% vs. 19.1%, OR = 1.353, P = 0.139) between two study groups. Present results suggested that CTLA-4 and CD28 gene polymorphisms did not play an important role in Turkish patients with CRC.

Magnetic resonance cholangiopancreatography in cholestatic diseases.

BACKGROUND/AIMS: To evaluate the usefulness of magnetic resonance cholangiopancreatography in cholestasis. METHODOLOGY: Sixty-seven patients with cholestasis underwent ultrasound and magnetic resonance cholangiopancreatography, subsequently. The results of ultrasound and magnetic resonance cholangiopancreatography were interpreted by two independent radiologists. RESULTS: According to ultrasonographic findings intra- and extrahepatic cholestasis were diagnosed in 62.7% and 37.3% of patients, respectively. Magnetic resonance cholangiopancreatography revealed intra- and extrahepatic cholestasis in 52.2% and 47.8% of patients at the same group, respectively (p=0.016, kappa=0.789). Endoscopic retrograde cholangiopancreatography was indicated in 37.3% of patients (22.4% diagnostic, 14.9% therapeutic) according to ultrasonographic findings. However, 41.8% of patients had indication for endoscopic retrograde cholangiopancreatography following magnetic resonance cholangiopancreatography in the same group. In 20% of patients who needed diagnostic endoscopic retrograde cholangiopancreatography according to ultrasonographic findings, endoscopic retrograde cholangiopancreatography wasn't indicated after magnetic resonance cholangiopancreatography. Similarly, 8.9% of patients who didn't have indication for endoscopic retrograde cholangiopancreatography according to ultrasonographic findings underwent endoscopic retrograde cholangiopancreatography (p=0.508, kappa=0.72). CONCLUSIONS: Magnetic resonance cholangiopancreatography is valuable in diagnosis of extrahepatic cholestasis in patients suspected with intrahepatic cholestasis according to ultrasonographic findings. Magnetic resonance cholangiopancreatography does not prevent endoscopic retrograde cholangiopancreatography requirement significantly in patients who need diagnostic endoscopic retrograde cholangiopancreatography following ultrasonography.

Is the local acid output an important factor for Helicobacter pylori colonization?

BACKGROUND/AIMS: Low local acid production is considered to be an important factor for Helicobacter pylori colonization. The increased bacterial density and inflammation are expected in cardiac mucosa because of low acid secretion. We aimed to investigate the bacterial density and the histologic pattern of gastritis in the cardia, and to compare with those of the antrum and corpus. METHODOLOGY: The biopsy specimens taken from the antrum, corpus and cardia in 97 patients during endoscopy were examined histopathologically. RESULTS: The mean scores for bacterial density in the cardia, corpus and antrum were 1.32 +/- 0.35, 1.09 +/- 0.86, 1.42 +/- 0.97, respectively. Bacterial density of the cardia was significantly higher than that in corpus, but was similar to the antrum. The mean scores for the degree of gastritis in the cardia, corpus and antrum were 1.56 +/- 0.79, 1.64 +/- 0.75, 1.85 +/- 0.77, respectively. Gastritis was significantly more severe in the antrum than in the corpus and cardia. The activity scores of gastritis in the three regions were statistically similar. CONCLUSIONS: Although bacterial density in the cardiac mucosa were found to be high, the degree of gastritis was low.

The value of pre-emptive analgesia in the treatment of postoperative pain after laparoscopic cholecystectomy.

BACKGROUND AND AIM: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with pre-operative administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after laparoscopic cholecystectomy. METHODS: 45 patients undergoing laparoscopic cholecystectomy were randomized into three groups. Bupivacaine was injected into the area of skin incision before trocar entry and after trocar removal in group 1 and 2, respectively; however, this procedure was not applied to the control group. The pain score of the patients was evaluated by the visual analogue scale (VAS) at 1, 4, 12( )and 24 h after surgery. The daily analgesic requirement was evaluated in terms of diclophenac sodium (Diclomec, Abdi Ibrahim, 75 mg) intake/day. Analgesics were given to the patients whose VAS was 5 or higher. RESULTS: While there was no significant difference in VAS scores between group 1 and 2, the mean pain scores of these two groups were found to be significantly lower than of the control group although the analgesic requirement of the patients in each group was not statistically significant. CONCLUSION: Pre-emptive analgesia is as effective as postsurgical local anaesthesia in reducing postoperative pain.

Nitroderm TTS band application for pain after hemorrhoidectomy.

PURPOSE: Anal sphincter spasm is believed to play an important role in pain after hemorrhoidectomy. We tested a different form of nitroglycerin: the Nitroderm TTS band. We investigated its efficacy on posthemorrhoidectomy pain and the relation between pain and anal resting pressure measured preoperatively and postoperatively. METHODS: Thirty-eight hemorrhoid patients were divided into two groups: those with high anal resting pressure were classified as group A (n = 24) and those with low anal resting pressure were classified as group B (n = 14). After hemorrhoidectomy, Nitroderm TTS bands were placed into the anal canal in half of the patients in groups A and B (groups A-1 and B-1) and not in the remaining half (groups A-2 and B-2). Anal resting pressure measurement was repeated at the first day and third month postoperatively. Postoperative pain was assessed by linear analog scale, and analgesic consumption was recorded. RESULTS: Preoperative anal resting pressure was 112.0 (range, 95-140) cm H2O in group A-1 and 110.6 (range, 96-138) cm H2O in group A-2. The difference was insignificant. However, on the first postoperative day, anal resting pressures were 88.7 (range, 75-115) and 110.9 (range, 92-135) cm H2O (P = 0.0001), and at the third month, they were 76.5 (range, 70-100) and 78.0 (range, 70-105) cm H2O, respectively (P = 0.690). Postoperative pain scores were significantly lower in group A-1 than group A-2 (P = 0.0001). In the low-pressure groups (B-1 and B-2), anal resting pressures before surgery, on the first postoperative day, and at the third month postoperatively were 70.4 (range, 56-76), 67.4 (range, 50-75), and 67.2 (range, 55-74) cm H2O in group B-1 and 69.8 (range, 58-76), 70.2 (range, 60-76), and 68.4 (range, 60-74) cm H2O in group B-2. The differences were insignificant (P > or = 0.660). The differences between pain scores in these groups were also insignificant (P > or = 0.160). CONCLUSION: Nitroderm TTS bands effectively reduced anal resting pressure and relieved pain in patients with high preoperative anal resting pressure.

Experimental sodium phosphate and polyethylene glycol induce colonic tissue damage and oxidative stress.

BACKGROUND: Bowel washout solutions may damage colonic mucosa and cause shallow ulceration, which may result in diagnostic errors and complications. The effects of polyethylene glycol (PEG) and sodium phosphate on rat colon were investigated histologically and by measurement of indicators of oxidative stress. METHODS: Thirty Wistar albino rats were divided into three groups and received PEG, sodium phosphate or tap water alone (control). After 8 h, histological changes in colonic mucosa were evaluated. The tissue concentration of malonyldialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in colon homogenates was also measured. RESULTS: Animals in the sodium phosphate and PEG groups had significantly more colonic mucosal damage than controls, the damage induced by sodium phosphate being worse than that caused by PEG. MDA levels were significantly higher in the sodium phosphate and PEG groups than in controls and were higher in the sodium phosphate group than in the PEG group, whereas differences in SOD and GSH-Px activities were significant only between control and both sodium phosphate and PEG groups. CONCLUSION: Sodium phosphate and PEG cause histological damage and trigger oxidative stress on colonic mucosa. The tissue damage and oxidative stress induced by sodium phosphate is more profound than that produced by PEG.

Modified technique for correction of gynaecomastia.

OBJECTIVE: To test a modification of the circumareolar incision for correction of a gynaecomastia from the points of view of complications and appearance of the scar. DESIGN: Clinical study. SETTING: Military and university hospitals, Turkey. SUBJECTS: 32 patients with gynaecomastia operated on between 1992 and 2000. INTERVENTIONS: Simon I patients were treated with an inferior semicircular periareolar incision (n = 12). Half of the Simon II patients had the same incision and the others were treated with a modified extended incision (n = 10 in each group). MAIN OUTCOME MEASURES: Haematoma, skin necrosis, nipple inversion, low-seated nipple, asymmetry, hypoaesthesia and hypertrophic scar. RESULTS: Simon II patients treated with the unmodified incision had more haematomas and seromas than Simon I patients and worse cosmesis (p = 0.009 and p = 0.02). However, the complication rates did not differ significantly compared with the Simon II patients who had the modified incision. CONCLUSION: A modified extended circumareolar incision results in fewer complication and better cosmesis in grade II gynaecomastia than the standard incision.

Systemic stress responses after laparoscopic or open hernia repair.

OBJECTIVE: To compare systemic stress responses after laparoscopic and open hernia repair to find out if the laparoscopic approach caused less stress than an open operation. DESIGN: Prospective randomised trial. SETTING: Teaching hospital, Sanliurfa, Turkey. SUBJECTS: 50 patients who required preperitoneal hernia repair were randomised to be treated by either the open or laparoscopic approach (n = 25 in each). INTERVENTIONS: Samples of venous blood were taken before operation and at 2, 24, and 48 hours afterwards for measurement of the concentrations of: glucose, cortisol, malonyldialdehyde (MDA), C-reactive protein (CRP), creatine phosphokinase (CPK), caeruloplasmin, transferrin, fibrinogen, and albumin, and counts of leucocytes, neutrophils, and lymphocytes. MAIN OUTCOME MEASURES: Changes in these indicators of a stress response. RESULTS: Concentrations of glucose, cortisol, CRP, MDA, and CPK, and counts of leucocytes and neutrophils increased significantly, and the concentration of albumin decreased significantly, in both groups postoperatively. Lymphocyte counts were lower postoperatively but not significantly so. Concentrations of CRP, MDA, and CPK, and leucocyte counts were significantly lower in the laparoscopic group. CONCLUSION: These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair.

Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure.

PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

Effects of antiadhesive agents on the healing of intestinal anastomosis.

PURPOSE: The effects of antiadhesive agents on the healing of intestinal anastomosis were investigated. METHODS: Eighty rats were divided into eight groups. Colotomy and anastomosis were performed to all rats. Saline solution (control), carboxymethylcellulose, aprotinin, verapamil, tenoxicam, cyclosporine, and dextran 70 were administered intraperitoneally. Vitamin E was administered intramuscularly. The rats were killed 15 days later. Anastomotic healing was assessed by bursting pressure and the hydroxyproline content of the anastomotic tissues. The results were evaluated by Mann-Whitney U test. RESULTS: The mean (+/- standard deviation) bursting pressures of carboxymethylcellulose, cyclosporine, and aprotinin groups (108 +/- 6.73, 122.5 +/-14.39, and 127 +/- 20.23, respectively) were significantly lower than those of the control group (234 +/- 6.19). The mean level of hydroxyproline in the anastomotic tissues was significantly lower in the carboxymethylcellulose and cyclosporine groups (8.92 +/- 0.6 and 8.32 +/- 0.63) than that in the control group (16.33 +/- 0.68). CONCLUSION: These findings indicate that carboxymethylcellulose and cyclosporine had adverse effects on intestinal anastomosis in rats.

Incidence and aetiological factors in pilonidal sinus among Turkish soldiers.

OBJECTIVE: To study the incidence and causes of pilonidal sinus in Turkish soldiers. DESIGN: Open study by questionnaire. SETTING: Military and University hospitals, Turkey. SUBJECTS: 1000 soldiers who presented for their first medical examination. MAIN OUTCOME MEASURES: Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus. RESULTS: 88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001). CONCLUSIONS: Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if the aetiological factors are understood.