The relationship between fecal incontinence and vaginal delivery in the postmenopausal stage.

OBJECTIVE: Obstetric anal sphincter injuries are one of the most significant complications of vaginal delivery that give way to fecal incontinence, which is defined as the involuntary leakage of gas, fluid or solid stool. Although sphincter injuries are seen in 0.5-9% of all deliveries. It has been reported that 20-41% of women who had vaginal deliveries had occult anal sphincter injuries as endoanal ultrasonography began to be used by physicians. The aim of our study was to investigate the relationship between fecal incontinence, whose incidence increases dramatically during the postmenopausal stage, and occult anal sphincter injuries. MATERIALS AND METHODS: Two hundred healthy female patients with no history of anal sphincter injury, aged between 18 and 70 years were included in the study. The participants were divided into 4 groups according to their menopausal stages and mode of delivery; premenopausal (group 1) and postmenopausal (group 2) vaginal delivery, and premenopausal (group 3) and postmenopausal (group 4) cesarean section. Wexner incontinence scores were determined. The participants' defects were assessed using endoanal ultrasound and their status of fecal incontinence using anorectal manometric measurements. RESULTS: Anorectal manometric measurement results were found significantly lower in group 1 than in group 3 (p<0.01). The Wexner scores of groups 1 and 3 were similar. The anorectal manometric measurement results of group 2 were significantly lower than those of group 4, and the Wexner score of group 2 was significantly higher than other groups (p=0.03). CONCLUSION: Anal sphincter injuries formed after vaginal delivery may be one of the reasons that increase the incidence of postmenopausal fecal incontinence and cause the formation of fecal incontinence symptoms in women.

The effects of flavanoid on the treatment of hepatopulmonary syndrome.

PURPOSE: Hepatopulmonary syndrome is an arterial oxygenation disorder brought about by advanced liver failure and pulmonary vascular dilatations. The reason why hypoxia develops in hepatopulmonary syndrome depends on the broadening of perialveolar capillary veins. Our study aims to investigate the effects of Flavanoid on hepatopulmonary syndrome through its inhibition of nitric oxide. METHODS: Three groups, each having 8 rats, were formed within the scope of our study. Group I (the control group) only received laparatomy, group II received choledoch ligation, and group III was administered Flavanoid (90% flavonoid diosmin, 10% flavonoid hesperidin) following choledoch ligation. The rats were administered Flavanoid at week two following choledoch ligation. The rats' livers and lungs were examined histopathologically following a five-week follow-up and the perialveolar vein diameters were measured. Arterial blood gases and biochemical parameters were evaluated. RESULTS: It was seen that fibrosis and oxidative damage in the liver with obstructive jaundice as well as hypoxia with pulmonary perialveolar vein sizes were significantly lower than the other group with cirrhosis formed through the administration of Flavanoid. CONCLUSION: We have concluded that Flavanoid administration might be useful in the treatment of hypoxia in hepatopulmonary syndrome and the delay of cirrhosis contraction.

The effects of selenium and vitamin E on lung tissue in rats with sepsis.

PURPOSE: In this study we examined the ability of selenium and vitamin E to prevent sepsis-induced changes in lung tissue. METHODS: Fifty rats were divided into five groups: Group 1: Control group; Group 2: Sepsis group. In this group only cecal ligation and perforation (CLP) was performed. Group 3: Selenium group. An intraperitoneal dose of 100 µg selenium was given for the first two days followed by a daily dose of 40 µg for the next five days. CLP was performed the following day. Group 4: Selenium and vitamin E group. In addition to selenium, vitamin E was given intramuscularly in a dose of 250 mg/kg/day for seven days. CLP was performed the following day. Group 5: Vitamin E group. Vitamin E was given intramuscularly in a dose of 250 mg/kg/day for seven days. CLP was performed the following day. RESULTS: There were significant differences between Group 2 and all other groups in terms of blood gas values (pH, pCO2, SaO2), and leukocyte, C-reactive protein (CRP) and glutathione peroxidase levels (p < 0.005). There was no statistically significant difference between groups 3, 4 and 5 in terms of histopathological changes in lung tissue (p > 0.05), but all groups were significantly different compared with Group 2 (p < 0.05). CONCLUSION: Sepsis-induced lung tissue damage can be reduced or prevented by pre-treatment with of selenium and/or vitamin E in a rat model.

Clinical and surgical profile and follow up of patients with liver hydatid cyst from an endemic region.

AIM: The aim of this study is to present the changes in the treatment of liver hydatid cyst during the last 20 years in our clinic according to literature data. MATERIAL AND METHODS: Clinical, laboratory and operational findings and pre- and postoperative complications of 650 from 700 patients with liver hydatid cysts, examined and treated at Selcuk University Meram Medicine Faculty, General Surgery Department, between 1985-2005, were evaluated in two groups: 1st period (1985-1995) and 2nd period (1995-2005). RESULTS: 436 of the cases were females (67.1%) and 214 (32.9%) males. The mean age of the females was 35 years (ranges 10-73) and of the males 46 years (ranges 12-76). Surgical treatment comprised radical and obliterative conservative techniques in the first period, while non-obliterative conservative techniques and percutaneous puncture and aspiration of the cyst, injection of scolex eliminating substance and reaspiration (PAIR) were preferred in the second period. During the follow-up (498 cases were followed for a mean period of 32 [12-72] months), recurrence occurred in 12 in the first period and in 9 in the second period, a total of 21 patients (4.21%). CONCLUSION: We consider that regardless of the surgical treatment used in liver hydatid cyst cases, combination with chemotherapy is the safest and most effective approach.

Intraoperative determination of intestinal viability: a comparison with transserosal pulse oximetry and histopathological examination.

BACKGROUND: In this study, we aimed to measure the O2 saturation of ischemic intestinal segments and the relationship between these measures and concomitant pathological gradings. MATERIALS AND METHODS: We used 14 New Zealand White rabbits, anesthetized with a combination of 80 mg/kg (i.m.) Ketamine hydrochloride and 10 mg/kg Acepromazine (i.m.). The superior mesenteric artery (SMA) was explored, and O2 saturation was measured by pulse oximetry 5 cm proximal to the ileocecal valve at the 0th hour. At the same time a 0.5-cm full-thickness wedge biopsy was taken from the same region. Thereafter, the SMA was ligated and the abdomen was closed. All rabbits were undertaken relaparotomy at the 4th hour; O2 saturation was measured by pulse oximetry at 5 cm away from the region of the first biopsy and a 0.5-cm full-thickness wedge biopsy was taken. The abdomen was then closed. The same procedure was performed at the 8th and the 12th hour. Mucosal hemorrhage, transmural congestion, mucosal necrosis, and transmural necrosis were examined in the specimens. RESULTS: Pathologically, transmural necrosis was concomitant with 64% O2 saturation (sensitivity: 100%; specificity: 86%). Mucosal necrosis was concomitant with 76% O2 saturation values (sensitivity: 100%; specificity: 75%). Transmural congestion was concomitant with 81% O2 saturation values (sensitivity: 89%; specificity: 58%). Mucosal hemorrhage was concomitant with 91% O2 saturation (sensitivity: 100%; specificity: 31%). CONCLUSION: O2 saturation measures > 76% may indicate reversible changes as mucosal necrosis, transmural congestion, or mucosal hemorrhage, and O2 saturation measures < 64% may indicate permanent transmural necrosis. As a result, intraoperative evaluation of intestinal viability by pulse oximetry may give us an idea about the degree of pathological changes and subsequently might reduce the number of second-look operations.

[Diaphragmatic rupture in abdominal trauma]. / Karin Travmasinda Diyfragma Rüptürü.

BACKGROUND: The aim of the study is to evaluate the patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma. METHODS: Thirty-eight patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma were investigated retrospectively. RESULTS: The average age was 41,72 and there were 31 male and seven female patients. The injury forms were penetrating trauma in 22 (58%) and blunt trauma in 16 (42%) cases. Associated abdominal organ injuries were found in 27 (71%) cases. Among 47 diaphragmatic ruptures, 27 (57%) were on the left and 20 (43%) were on the right side. The average diameter of the rupture was 5,45 (1-20) cm. Management of the diaphragmatic rupture and other associated organ injuries were accomplished through laparotomy. Morbidity was developed in 18 cases and mortality in four cases with associated abdominal organ injuries. CONCLUSION: Diaphragmatic rupture results in high morbidity and mortality due to associated organ injuries.