Assessment of the results of a three-year program for National Standardization and Quality Improvement of Medical Laboratories on Drug of Abuse Testing by the Ministry of Health in Turkey.

The aim of this study is to assess the results of inspections in the last three years of drug abuse testing in medical laboratories according to the latest regulations in Turkey. The on-site inspections of medical laboratories for drugs abuse testing performed in Alcohol and Drug Addiction Treatment Centers during 2014-2016 are described, and laboratory processes and performance evaluated. The performance of 35 laboratories in 2014, 62 laboratories in 2015, and 94 laboratories in 2016 were scored as the sum of the scores for all answers on the inspection form. An inspected laboratory was considered to have an unconformity if the total score was less than 2/3 of maximum score. The total scores of inspections and the number of laboratories with between years were compared using one-way analysis of variance and slope Chi-square for trend test, respectively. Total scores increased statistically significantly from 35.9 ± 16.2 in 2014, to 43.5 ± 16.3 in 2015 and 49.1 ± 1.3 in 2016 (p < 0.001). The laboratories with unconformities decreased statistically significantly from 57% in 2014 to 37% in 2015 and 22% in 2016 (p < 0.001). The published legislation and the inspections contributed to national standardization and improved quality of service in medical laboratories for drug abuse testing.

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis.

OBJECTIVES: Complications after colorectal surgery have not been reduced in recent years. Anastomotic leakage is responsible for nearly all morbidity in colonic surgery and for about one third of the mortality. MATERIAL AND METHODS: For the study, 34 albino Wistar rats (about 155-190 g in weight) were divided into four experimental groups. Each of the rats underwent an abdominal incision and resection of the colon 4 cm distal to the cecum to form a colo-colonic anastomosis. In the post-operative period, the first group (n=8) were fed with standard rat food and water, the second group (n=9) with dextrose+Ringer solution, the third group (n=9) with Biosorb® (Nutricia, Zoetermeer, The Netherlands), and the fourth group (n=8) with Impact® (Novartis Nutrition, USA). RESULTS: The blow-out pressure of the anastomoses was significantly different in the group fed 5% dextrose+Ringer solution group than in the Biosorb® and Impact® groups. CONCLUSIONS: None of the various nutrients investigated in the present study were significantly superior to standard foods in terms of the blow-out pressures. On the other hand, immunonutrients were more beneficial effects than other nutrients in terms of the healing of colonic anastomoses and post-operative weight loss.

Esophageal perforation due to inadvertent swallowing of a dental prosthesis.

Intentional or inadvertent swallowing of foreign bodies can lead to severe complications in the gastrointestinal tract, primarily in the esophagus, and requires an urgent approach. In children, coins are the most commonly seen foreign bodies in the esophagus. However, in adults, the solid components of meals, like bones, and in the elderly population dental prostheses are the most frequently observed ingested foreign bodies. Even though a swallowed dental prosthesis is usually seen as a geriatric problem, esophageal obstruction and/or perforation can occur in any denture user in any age group. Thus, the aim of this report was to present one of these interesting cases of esophageal perforation due to a partial denture ingestion and its treatment in a 32-year-old male.

[Case report: primary splenic hydatidosis]. / Olgu Sunumu: primer dalak kist hidatigi.

Hydatidosis, caused by Echinococcus granulosus is still an important problem in endemic areas as Middle and Eastern Europe including Turkey, South America, Avustralia, New Zealand and South Africa. Hydatid disease affects more common liver and lung. Isolated splenic hydatidoses are quite rare in the medical literature. Here we report a case of isolated primary splenic hydatid cyst which is treated by splenectomy.

Comparison between powdered gloves, powder-free gloves and hyaluronate/carboxymethylcellulose membrane on adhesion formation in a rat caecal serosal abrasion model.

OBJECTIVE: Intraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model. METHODS: Sixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day. RESULTS: There was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001). CONCLUSION: Our experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.

Gastric wall calcification in gastric cancer relapse: case report.

We present the case of a 53-year-old male with subtotal gastrectomy and gastrojejunostomy due to gastric cancer who later developed cancer relapse and diffuse plaque-like calcification in the residual gastric tissue. As far as we know, this is the first case in the English literature in whom gastric tumor calcification developed one year after gastric cancer operation. We also discuss possible mechanisms of gastric wall calcification in such cases.

Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease.

PURPOSE: Cases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period. METHODS: In this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6-44) months after wide excision plus classic Limberg flap (Group 1, n=35) and after asymmetric modified Limberg flap closure (Group 2, n=33). RESULTS: There were significantly more macerations in Group 1 (P<0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P=0.028). We noted that as a result of these complications, time to suture removal (P=0.001), discharge from hospital (P=0.001), and time off from work (P=0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P=0.493). CONCLUSIONS: The deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.

Importance of identifying the course of the recurrent laryngeal nerve in total and near-total thyroid lobectomies.

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

Medical haemostasis in acute hepatocyte injury and experimental liver trauma.

BACKGROUND: The aim of the present study was to test the effectiveness of aprotinin to reduce bleeding in liver resection of guinea pigs with acutely injured hepatocyte using intraperitoneal d(+)Galactosamine. METHODS: Thirty-two guinea pigs were divided equally into four groups. Group 1 was the control group. Group 2 received intraperitoneal D(+)galactosamine. Group 3 received intraperitoneal d(+)galactosamine prior to a standard liver resection. Group 4 received 10.000 KIU/kg aprotinin infusion via jugular catheter in 10 min prior to standard liver resection in pretreated animals with d(+)galactosamine. All of the measurements and surgical interventions were made 24 h after the administration of d(+)galactosamine. Bleeding amounts were recorded in groups 3 and 4 for 1 h by weighing the sponges placed into the abdomen. Liver function tests, histologic, haematologic and fibrinolytic parameters were measured. RESULTS: Hepatocyte injury and hyperfibrinolysis were seen at the end of 24 h after application of d(+)galactosamine in groups 2, 3, and 4. Statistically significant amounts of bleeding from the resected livers were observed in group 3 and 4. In group 4, the bleeding was reduced (P < 0.05) and fibrinolytic parameters were normalized (P < 0.05) with aprotinin infusion. CONCLUSIONS: Significant bleeding diathesis and hyperfibrinolysis occurred in groups 2, 3, and 4, which had hepatocyte injury proved with histopathologic and haematologic tests. Prothrombin time (PT) and partial thromboplastin time (aPTT) in groups 3 and 4 were fivefold higher than that in the control group (P = 0.0001). The bleeding tendency according to high PT and aPTT levels were continued with application of aprotinin while reduction of bleeding was seen. Parenchymatous organ haemorrhage in acute liver failure or hyperfibrinolytic conditions could be reduced significantly with aprotinin without procoagulant effect.

A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies.

PURPOSE: Recurrent laryngeal nerve palsy and hypoparathyroidism are the most common and serious complications after thyroid operations. Surgeon experience has been defined as a significant factor in the number of complications occurring in thyroid surgery. There has so far been no prospective randomized study that compares the complication rates between residents and the attending surgeon in statistically similar patient groups in which all of the patients undergo the same type of thyroid surgery by the same surgical team. In this prospective study the performances of residents and attending surgeons were evaluated and compared according to the complication rates in near-total thyroidectomies. METHODS: One hundred and fifty-two patients underwent near-total thyroidectomies between April 2001 and May 2003. The number of randomly selected patients operated on by residents at the level of postgraduate year two, under the direct supervision of an attending surgeon, and the number of patients operated on by attending surgeons were 78 and 74, respectively. All patients had preoperative and postoperative videolaryngostroboscopic examinations of the vocal cords and serum calcium level evaluation. RESULTS: The rates of temporary vocal cord paralysis with respect to the nerves at risk for residents and attending surgeons were 3.7% and 2.7%, respectively. The temporary hypoparathyroidism rate was 8.1% for attending surgeons, whereas it was found to be 6.4% for residents. Neither any cases of permanent vocal cord paralysis nor permanent hypoparathyroidism were detected. CONCLUSION: Our results indicate that the complication rates in near-total thyroidectomies performed by residents and attending surgeons are similar. Thyroid surgery can therefore be safely and effectively performed by residents under close supervision.

Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions.

HYPOTHESIS: Near-total thyroidectomy, on the basis of its low morbidity rate, is an appropriate treatment option in the surgical management of various thyroid diseases in an endemic region in Turkey. DESIGN: Single-institution study of patients with various thyroid diseases treated by means of near-total thyroidectomy within 2 years in an endemic region, with comparison of the results vs the complication rates of bilateral subtotal and total thyroidectomy reported in the literature. SETTING: Tertiary academic referral center. PATIENTS: One hundred fifty-two patients who underwent near-total thyroidectomy for various thyroid diseases. MAIN OUTCOME MEASURES: Surgical treatments of various benign thyroid diseases were compared according to the complication rates and the achievable benefits of the procedures. RESULTS: In our clinic, near-total thyroidectomy was the principal surgical procedure performed for benign thyroid disease. The temporary recurrent laryngeal nerve palsy rate with respect to the nerves at risk was 3.3% (10 of 304 nerves), whereas temporary hypoparathyroidism was 7.2% (11 of 152 patients). Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism occurred. In 1 patient, wound hematoma developed and required re-exploration. Seroma in another patient needed no medical or surgical intervention. Neither wound infection nor mortality were noted. CONCLUSIONS: Near-total thyroidectomy achieves a lower complication rate of hypoparathyroidism and a similar complication rate of recurrent laryngeal nerve palsy and recurrence when compared with the rates reported in the literature for total thyroidectomy. It is an effective and safe surgical treatment option for various benign thyroid diseases.

Modified Limberg transposition flap for sacrococcygeal pilonidal sinus.

PURPOSE: To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus. METHODS: We analyzed the well-documented records of 238 patients with sacrococcygeal pilonidal sinus who underwent wide excision with a Limberg transposition flap and were followed up for longer than 1 year postoperatively. After the first 40 operations, we modified this flap reconstruction by tailoring the rhomboid excision asymmetrically to place the lower pole of the flap 1-2 cm lateral to the midline. Wound infection rates, hospitalization, time required for free mobilization, and recurrence rates were recorded. RESULTS: Postoperative infection developed in two patients (0.8%), which was easily managed by wound care, antibiotics, removal of skin staples, prolonged drainage, or a combination of these treatments. The mean hospitalization was 2.10 +/- 0.20 days (range 1-3 days), and the mean time required for recovery and return to daily activities was 8.00 +/- 2.50 days (range 4-17 days). There were only three recurrences (1.26%) after a mean follow-up of 29.20 +/- 3.10 months (range 12-38 months). Since we started performing our modification of the technique by lateralization of the inferior apex, no further recurrences have been seen. The recurrence rate differed significantly between the classical Limberg flap group and the modified Limberg flap group ( P = 0.004) CONCLUSION: These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.

Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery.

BACKGROUND: The present study analyses the results of wide excision with primary closure (PC), wide excision with classical Limberg flap reconstruction (LF) and wide excision with modified Limberg flap reconstruction (MLF) in the surgical treatment of sacrococcygeal pilonidal disease. METHODS: One hundred and sixty-two well-documented patients who were operated on for pilonidal disease and followed for more than 1 year were analysed retrospectively. Group 1 was composed of patients with excision plus PC (n = 78) while group 2 included those with excision plus a LF reconstruction (n = 40), and group 3 included those with excision plus a MLF reconstruction (n = 44). RESULTS: There were no significant differences among the three groups with respect to age, sex distribution, frequency of recurrent disease, or follow-up periods (P > 0.05 for all comparisons). Significant disadvantages regarding postoperative infection rate, mobilization time, discharge from hospital, and time off work were noted for primary closure, compared with both LF and MLF reconstructions. Following a median follow-up period of 4.2 years, 14 recurrences (17.9%) developed in the PC group, three (7.5%) in the LF group, and none (0%) in the MLF group. The zero recurrence rate in the MLF group was significantly lower than that in the PC group (P = 0.003). On the other hand, the recurrence rate in the LF was not found to differ significantly from that in the PC group (P = 0.126). Comparing the LF and MLF groups, none of the surgical end points reached a statistically significant difference (P > 0.05 for all comparisons). CONCLUSIONS: For the surgical treatment of sacrococcygeal pilonidal disease, excision plus a classical or modified Limberg flap reconstruction proved to be superior to excision plus primary closure in terms of infection, mobilization time, discharge from hospital and time off work. Additionally, MLF reconstruction resulted in a statistically lower recurrence rate when compared with PC.

Comparison of the measurement methods of bursting pressure of intestinal anastomoses.

BACKGROUND/AIMS: This study was designed to determine whether there exists a difference between in vivo and in vitro measurements of bursting pressure (BP) of experimental intestinal anastomosis studied in Wistar-albino rats. METHODOLOGY: In the first group (n=8), the BP was measured using in vivo method without detaching the adhesions around the anastomosis. BP was determined with digital manometer, and then anastomotic region was removed to measure tissue hydroxyproline (HP) levels. In the second group (n=8), the BP was measured with in vitro method after the segment of intestine including the anastomosis was dissected and isolated. The isolated specimen was then submerged in a normal saline bath. BP was determined with a digital manometer and anastomotic region was removed to measure tissue HP levels. RESULTS: While HP value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 121.11 +/- 16.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.195). The BP was determined as 240.71 +/- 11.65 mmHg in the first group, 144.71 +/- 16.41 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found to be statistically different whereas tissue HP levels were normal between the groups. CONCLUSIONS: These results make us consider that mechanical changes occur about the isolated anastomotic line and dissection of adhesions weakens the anastomosis.

Comparison of the experimental intestinal anastomoses performed by different surgeons.

BACKGROUND/AIMS: This study was designed to determine the effects of different surgeons on the experimental anastomosis studied in rats. METHODOLOGY: Sixteen Wistar-albino rats were equally separated into two groups. The rats operated on by the first surgeon were coded Group 1 and operated on by the other surgeon were coded Group 2. Both surgeons were trained on the gastrointestinal surgery. The procedure of the study were standardized and dictated to the surgeons. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomotic strength and healing on the seventh day postoperatively. RESULTS: The bursting pressures were measured with a digital manometer and anastomotic lines were removed to measure tissue hydroxyproline level. While hydroxyproline value in the first group was 105.60 +/- 9.43 microg/mg dry tissue, it was found to be 104.02 +/- 17.26 microg/mg dry tissue in the second group and this difference was not statistically significant (p=0.521). The bursting pressure was determined as 240.71 +/- 11.65 mmHg in the first group, 190.75 +/- 14.09 mmHg in the second group and the difference was statistically significant (p=0.002). The anastomotic resistances to intraluminal pressure were found statistically different whereas tissue hydroxyproline levels were normal between the groups. CONCLUSIONS: These results make us to consider mechanical differences occur related to the surgeons in the studies performed with the same technical detail.