Awareness and wound assesment decrease surgical site infections.

Objectives: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine prac- ticality of SSI risk assessment methods (SENIC and NNIS) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure and evaluation of the contribution of wound assesment to the reduction of wound infection. Material and Methods: Patients were followed with a prospective data chart through four year. Correlation of SENIC and NNIS together with ASEPSIS were performed. Results: During the study period, 275 SSI occurred. SSIs were determined within the 21 days-period after operations. Correlation between SENIC with ASEPSIS (rs= 0.41, p <0.001) was found better than that for NNIS with ASEPSIS (rs= 0.37, p <0.001). Type of operation (emergency vs. elective), body mass index, operation class and American Society of Anesthesiologists scores were found independently predictive factors for SSI. The forth year SSI rate was found to be significantly lower than the other years (p <0.001). Conclusion: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS method. In addi- tion, surgical wound assesment and awarness of the wound infection rates, have decreased the SSI rates over the years.

The rising trend of papillary carcinoma in thyroidectomies: 14-years of experience in a referral center of Turkey.

BACKGROUND: During the past 25 years, the incidence of thyroid papillary carcinoma (TPC), especially the micropapillary subtype, has been increasing in different countries worldwide. The rise in the rate of thyroid malignancies were also determined in Turkey in the last two decades. This fact was attributed to the Chernobyl accident because Turkey is one of the affected countries by the radioactive fallout. The aim of this study was to assess the changes in the parameters of the thyroid and put forth the reasons in a 14-year period. METHODS: The patient records, demographic and malignancy characteristics, and operations of 1,585 patients who had a thyroidectomy from 1996 to 2009 were reviewed retrospectively. The study was divided in two equal time periods for comparison of data. RESULTS: A total of 216 thyroid carcinomas (13.6%) were diagnosed in the study period. There was a significant increase in the frequency of papillary (P <0.023) and micropapillary (P <0.001) carcinomas when the two different time periods were compared. The rate of follicular, medullary and other types of malignancies did not change. In the second period (2003 to 2009) of analysis, the rate of micropapillary carcinoma (P = 0.001) and within male (P = 0.031) and female (P <0.001) genders, application of total thyroidectomy (p = 0.029), and multicentric disease (P = 0.015) increased significantly. A slight decrease in the mean age of the whole number of patients and patients with papillary and micropapillary carcinomas (P >0.05) was observed. The increased number of TPC >10 mm was insignificant. Geographic region and age specific malignancy increase was not determined. CONCLUSIONS: Micropapillary carcinoma has become a dominant type of thyroid malignancy in Turkey. The main reasons of this transition were mandatory iodization and much higher application of total thyroidectomy in surgery. Improvement in healthcare and diagnostic techniques are the complementary factors. Due to its lack of molecular and genetic basis from the perspective of thyroid cancer, the Chernobyl disaster has lost its importance in Turkey.

Isolated intrathoracic hiatal herniation of the twisted sigmoid colon: report of a case.

The hiatus hernia and sigmoid volvulus are usually found in older patients. The delay of the treatment of both of these illnesses may result in increased morbidity and mortality. We report a case of an isolated intrathoracic hiatal herniation of the twisted sigmoid colon. The patient complained about cramping abdominal pain, vomiting, and dyspnea. Chest X-ray and CT scan of the thorax showed a distended colonic segment in the posterior mediastinum. The patient underwent cruroplasty, Nissen fundoplication, and sigmoid colon resection. This is the first report of such a rare case.

Conservative management of hemorrhoids: a comparison of venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy.

PURPOSE: To compare the results of the conservative management of hemorrhoids between venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy, in terms of the subjective and objective outcome of patients after a follow-up period of 2 years. METHODS: One hundred and twenty-six patients who suffered from 1st-and 2nd-degree hemorrhoids were divided into 2 groups. The first (n = 64) and second (n = 62) groups underwent venotonic flavonoid MPFF (VF) and sclerotherapy (SCL). The Average Symptoms Score (ASS), Average Anascopy Score (AAS) and the subjective scale were used to assess the success of the treatments. RESULTS: A total of 113 patients agreed to participate in the follow-up study. ASS and AAS decreased in both of the groups in the first three visits (P < 0.05). At the end of the second visit, ASS and AAS significantly declined in the VF group. In addition, ASS and AAS decreased to the nadir level in the groups at the end of the 26th week. During the remaining time of the follow-up period, ASS showed a significant rise pattern in the VF group in comparison to the SCL group. The resolved and improved rate was significantly higher in the SCL group at the end of the study (P < 0.05). CONCLUSIONS: Sclerotherapy was a more efficient treatment modality than VF in the long-term follow-up. SCL also had an acceptable success rate in the short-term follow-up.

Correlation of risk and postoperative assessment methods in wound surveillance.

BACKGROUND: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure. MATERIALS AND METHODS: Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed. RESULTS: During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI. CONCLUSIONS: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.

Serum tumor marker CA19-9 in the follow-up of patients with cystic echinococcosis.

BACKGROUND: The aim of this study was to compare results of the determination of carcinoembryonic antigen, carbohydrate antigens, alpha-fetoprotein, and human chorionic gonadotropin before and after surgical and pharmacologic treatment in patients with cystic echinococcosis (CE). METHODS: Serum samples were obtained from 40 CE patients (all with cysts in the liver) and from 10 sex- and age-matched healthy donors (control group). Serum samples were drawn (1) before (presurgical group) and after (postsurgical group, including a 3-month cycle of albendazole) surgical and pharmacologic treatment. Serum tumor markers were measured, and indirect hemagglutination assay was performed. RESULTS: In 90% of confirmed cases of CE, indirect hemagglutination assay was positive. Mean (SD) serum CA19-9 concentrations for all patients in the presurgical and postsurgical groups were 45.1 +/- 30 kU/L and 17.02 +/- 11 kU/L, respectively. CA19-9 concentrations were significantly greater in CE patients in the presurgical compared with the control group. Also, increased CA19-9 concentrations decreased significantly in the postsurgical compared with the presurgical group. CONCLUSIONS: A significant decrease in serum CA19-9 concentrations after surgical and pharmacologic therapy was demonstrated in the clinical follow-up of patients with CE (patients were tested 3 months after surgery). If our findings are confirmed and more-sensitive methods are developed for measuring serum CA19-9 concentrations, new and interesting perspectives will be gained for the monitoring and treatment of patients with CE.

Hemodiafiltration treatment for high bilirubinemia state after hepatectomy.

Hyperbilirubinemia which developed after right hepatectomy is reported in a 66-year-old male. The application of hemodiafiltration treatment in the postoperative course of the patient and the effect of treatment in his healing process are summarized and discussed.

Reinforcement of the suture line with an ePTFE graft attached with histoacryl glue in duodenal trauma.

BACKGROUND: Most duodenal injuries are managed with primary repair, but the degree of duodenal-wall injury may threaten the integrity of the primary repair. Therefore, we evaluated whether the primary repair site could be reinforced with histoacryl glue (HAG) or HAG with an expanded polytetrafluoroethylene (ePTFE) mesh. METHODS: Grade 3 duodenal injury in the second portion of the rat duodenum was chosen as a standard trauma model. Thirty-three male rats were divided into sham (n = 3), 2-layer primary repair (n = 10), 1-layer primary repair plus HAG application (n = 10) and ePTFE attached with HAG over the 1-layer primary repair site (n = 10) groups. Ten-day survival, adhesion grades and histological assessment were taken as outcome measures. RESULTS: A significant survival advantage was identified in the group that had an ePTFE graft attached with HAG over a 1-layer repair when compared with the group that had a 2-layer primary repair. Adhesion grades were found to be particularly increased in the group that had an ePTFE graft attached with HAG over the primary repair site, moderately increased in the primary repair plus HAG application group and lower in the 2-layer primary repair group. ePTFE graft application was found to be beneficial to coverage of the HAG-dependent empty spaces in the serosal layer. CONCLUSIONS: A primary repair site after duodenal trauma or a difficult duodenal stump can be reinforced with the application of HAG or ePTFE graft implantation with HAG.

Comparison of bariatric and non-bariatric elective operations in morbidly obese patients on the basis of wound infection.

BACKGROUND: Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. METHODS: A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. RESULTS: Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. CONCLUSION: Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

Primary hydatid cyst of the breast with elevated CA 19-9 level.

Breast masses secondary to hydatid cyst disease are placed on the differential diagnosis of breast tumors under guidance of the literature. In addition to their characteristic appearance on mammography, many specific parameters for diagnosis are required. In this report, the relation of serum CA 19-9 levels to the primary breast cyst hydatid was evaluated in both preoperative and postoperative periods.

Induction and assessment methods used in experimental adhesion studies.

Infertility and intestinal obstruction are well-known complications, arising from adhesion formation after intra-abdominal operations. Basic principles of adhesion formation have been found through animal studies. In addition, examination of agents for the prevention of adhesions can be easily made using experimental studies. However, lack of uniformity in study design makes assessment of the efficacy of any prophylactic regimen difficult. In this review, the material and methods used in experimental studies designed for adhesion formation or prevention were evaluated in detail, with experimental studies published in the literature from 1960 to 2003 being evaluated. Several methods for adhesion induction have been described in the literature. Severity of the adhesion varies from method to method, with the main problem being the lack of uniform expression of study results. Extensive use of complex adhesion classification systems should be used to resolve this discordance between experimental studies.

Effects of TVE application during 70% hepatectomy on regeneration capacity of rats.

BACKGROUND: For adequate control of excess bleeding during liver resection, total vascular exclusion (TVE) is preferred by surgeons, especially when the tumor is located in the posterior liver lobes or near the cava. To the authors' knowledge, the effects of TVE technique on the postoperative liver regeneration process have not thus far been evaluated yet in the literature. This study was planned to compare the effects of liver resections performed either with portal pedicle clamping or with TVE on the regeneration process. MATERIALS AND METHODS: Seventy percent hepatectomy was performed with portal pedicle clamping (n=10, Group A) or with TVE (n=10, Group B) in rats. At 48 h after resection, sampling was performed for the measurement of serum transaminase, alkaline phosphatase (ALP), tissue malondialdehyde (MDA), and glutathione (GSH) levels. Liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling, and mitotic indices were also evaluated. RESULTS: Liver injury determinants (serum transaminases, ALP, and tissue MDA levels) were found significantly higher in group B than in group A. Liver regeneration rate, liver GSH levels, PCNA labeling index, and mitotic index were significantly lower in group B than in group A. CONCLUSIONS: The injury during TVE seems to be greater than during resection with portal pedicle clamping. The negative effect of this oxidative damage may influence the regenerative capacity of the remnant liver tissue.

V-Y advancement flap closures for complicated pilonidal sinus disease.

BACKGROUND AND AIMS: Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study. PATIENT AND METHODS: Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V--Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16). RESULTS: None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline. INTERPRETATION AND CONCLUSION: Routine application of suction drains is not recommended after V--Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.

Improvement of vertical banded gastroplasty by strict dietary management.

BACKGROUND: Vertical banded gastroplasty (VBG) has been found to reduce BMI significantly during the first postoperative year. However, the same trend in weight loss has not been established thereafter. The purpose of this study was to evaluate the effects of our dietary program on morbidly obese patients treated with VBG. METHODS: A prospective evaluation of 40 obese patients (25 female, 15 male) undergoing VBG over a 3-year period was undertaken. RESULTS: The age range was 24-57 (median 38) years, mean weight 133+/-2 SD kg, and mean BMI 45+/-6.4 SD kg/m2. After VBG, a special follow-up program was applied to patients. All patients (100%) were available for follow-up. Operative mortality was zero. 4 patients developed an early postoperative complication, and 1 patient was re-operated because of staple-line disruption 8 months after VBG. BMI decreased to 34+/-3.2 after 12 months, 27+/-1.3 after 24 months, and 28+/-1.4 after 36 months. All patients showed weight loss after VBG, and the weight loss continued with the strict follow-up program during a 3-year period, except in 1 patient who regained the weight lost despite an intact staple-line and stoma. CONCLUSION: Our policy for patients after VBG appears to be effective.

The effects of nitric oxide synthase blockers on mesenteric blood flow with bile duct ligation.

BACKGROUND/AIMS: The aim of this study was to investigate the effects of nitric oxide synthesis inhibition by L-NNA (N-nitro-L-arginine) on mesenteric blood flow in bile duct ligated rats. METHODOLOGY: Forty female Wistar rats were allocated into four groups. Only common bile duct (CBD) was dissected with midline laparotomy (sham operated), CBD is ligated for obstructive jaundice (OJ group), with CBD dissection, 20 mg/kg L-NNA was given i.p. during 14 days (sham + L-NNA group), after CBD ligation, 20 mg/kg L-NNA was given i.p. during 14 days (OJ + L-NNA group). At the end of the 14th day, the rats were re-anaesthesized, phenylephrine was administered within the left jugular vein and, arterial blood pressure monitorization was done via left carotid artery. Blood flow of the mesenteric artery (SMA) was also recorded. Resistance of the SMA was calculated and in addition, pressure responses to phenylephrine were detected. Histopathological examination of the liver and blood analyses were done. RESULTS: The mean blood pressure levels of the rats with OJ were lower than the control group (P>0.05). Blood flow of the SMA and vascular resistance of the rats with OJ have no significant difference with other groups. In CBD ligated animals, mean blood pressure and mesenteric vascular resistance increased by L-NNA but there was no difference in mesenteric blood flow rate and vasoconstrictive response to phenylephrine. On microscopic examination of the liver with OJ, bile duct proliferation and minimal mononuclear reaction were observed which was not affected by L-NNA administration. CONCLUSIONS: Hypotension, low systemic vascular resistance, and a reduced sensitivity to vasoconstrictors are features of cirrhosis. In obstructive jaundice impaired vascular responsiveness to vasoconstrictor stimuli like as cirrhosis was not observed and also there was no improvement by L-NNA on histopathologic findings and liver function tests.

Jejunal perforation in mentally retarded patient due to an ingested chicken bone.

We report a mentally retarded case with jejunal perforation by ingested chicken bone. Foreign body ingestion constructs a health threat for mentally retarded people. Under guidance of the literature, travel of the bones in the gastrointestinal tract, diagnosis and treatment strategies are evaluated.

Retrorectal benign cystic teratoma misdiagnosed with high lying pararectal abscess.

A case of presacral teratoma with abscess formation is presented in this report. Teratomas, like the chordomas and dermoids, constitute the largest group of retrorectal tumors. Their presentation has varied. Dependent to unique localization, cystic teratoma complicated with abscess formation are misdiagnosed as high lying pararectal abscesses. Both diagnostic and therapeutic difficulties were evaluated with literature review.

Jejunal intussusception caused by an inflammatory fibroid polyp.

The case of a 56-year old male with a jejunal intussusception due to the inflammatory fibroid polyp is presented. In the literature, eleven cases with jejunojejunal intussusception due to IFP were reported. This rare entitiy was reviewed with different perspectives in this report.