A Novel Technique for the Management of Persistent Biliary Fistulas Developing After Liver Hydatid Cyst Surgeries: Drain Clamping Technique.

BACKGROUND: External biliary fistula, where the residual cyst is associated with the biliary tree, is one of the most common complications after liver hydatid cyst surgery. Surgical procedures become a consideration for patients in whom the biliary fistula persists despite all endoscopic procedures. However, reoperation for biliary fistula after hydatid cyst surgery leads to additional complications and increases morbidity and mortality. AIM: This study aims to treat persistent biliary fistulas that develop after liver hydatid cyst surgery using a simple noninvasive technique. MATERIALS AND METHODS: External drainage surgery was performed on 295 patients with liver hydatid cysts. Endoscopic treatment methods were used in patients who developed biliary fistula after surgery. Despite all endoscopic treatment methods, 14 patients developed persistent biliary fistulas. These patients were subsequently treated using the drain clamping technique. FINDINGS: All persistent fistulas occluded in 11.86 days (with a range of 8-20 days). No complications were observed in the one-year follow-up visits. CONCLUSION: Drain clamping, a novel approach to the treatment of persistent biliary fistulas developed despite all available endoscopic methods, can be safely used. This technique resulted in a complete recovery in patients without the need for surgical procedures.

Urinary angiotensinogen level is increased in renal transplant recipients with masked hypertension and is correlated with left ventricular mass index and albuminuria in these patients.

Activation of the local renin-angiotensin system (RAS) is an independent risk factor for the development of proteinuria and left ventricular hypertrophy (LVH) more commonly seen in masked hypertensives. It has been reported that urinary angiotensinogen (UAGT) level provides a specific index of the intrarenal RAS status. The aim of this study was to evaluate the association between UAGT and left ventricular mass index (LVMI) and urinary albumin-creatinine ratio (UACR) in renal transplant recipients (RTRs) with masked hypertension (HT). A total of 116 non-diabetic-treated hypertensive RTRs were included in this study. The patients were divided into two groups: masked hypertensives and controlled hypertensives. Forty-two (36.2%) of RTRs had masked HT. Mean UACR and LVMI levels were higher in RTRs with masked HT than in RTRs with controlled HT (P < 0.001). UAGT level was also higher in masked hypertensives compared to controlled hypertensives (P < 0.001). Multivariable regression analysis showed that UAGT was positively correlated with UACR (ß = 0.024, P = 0.001) and LVMI (ß = 0.082, P = 0.001) in masked hypertensives. Consequently, masked HT was considerably frequent (36.2%) in treated hypertensive RTRs and high UAGT levels accompanied by high albuminuria and LVMI levels were seen in these patients. Overproduction of the UAGT may play a pivotal role in the development of LVH and proteinuria in masked hypertensives.

Modified back wall first artery anastomosis technique in living donor liver transplantation.

BACKGROUND/OBJECTIVES: Back wall technique is usually used for hepatic artery anastomosis in living donor liver-transplantation. In this technique, two stitches are placed in the two corners of the artery wall initially and the microclamp on the artery is rotated to place the sutures to the back wall first. In some cases, the microclamp cannot be rotated because of insufficient length of the graft or recipient artery. If this occurs, it may be difficult to rotate the artery to perform the back wall artery anastomosis technique. In these cases, the difficulty of performing the anastomosis can cause intimal tears. Thus, we prefer a modified technique for artery anastomosis in such situations. METHODS: In this modified technique, two stitches are placed in the middle of the posterior wall and middle of the anterior wall initially. The artery is twisted 90° to the right side and to the left side respectively, instead of one 180° rotation, to place the back wall stitches. CONCLUSION: In this modified technique, reversing the microclamp is eliminated that can cause intimal damage. Therefore, it may be superior to the conventional method in terms of reducing the difficulty of performing anastomosis and intimal damage to the vessels.

[Evaluation of an acute mechanic intestinal obstruction case secondary to diaphragm rupture due to a blunt trauma]. / Künt travmaya bagli diyafram yirtigina sekonder akut mekanik intestinal obstrüksiyon olgusu.

Rupture of the diaphragm after blunt trauma is uncommon. In this report, a 24-year-old male with intestinal obstruction who underwent laparotomy is presented; he had been involved in a traffic accident three years prior to presentation to our emergency service. We conclude that diaphragma ruptures may cause herniation of abdominal organs and intestinal obstruction, and thus should be repaired when diagnosed.

An uncommon cause of pneumobilia: blunt abdominal trauma.

Pneumobilia is described as occurrence of free air in the gallbladder or biliary tree. There are a number of causes of pneumobilia, including surgically created biliary enteric fistula, instrumentation of the bile duct on endoscopic retrograde cholangiopancreatography, emphysematous cholecystitis, and pyogenic cholangitis. Pneumobilia has also occurred following blunt abdominal trauma, but to date, no more than five cases of such injury have been reported in the literature. In this report, we present a patient struck by a motor vehicle with traumatic pneumobilia following blunt trauma to the abdomen, which was managed conservatively.

[Primary omental torsion as a cause of acute abdomen: case report]. / Akut karina neden olan primer omentum torsiyonu: Olgu sunumu.

Torsion of the omentum is a rare pathology that was described 100 years ago. The characteristic appearance of omental torsion and a review of the literature are presented with respect to a case of primary omental torsion that was causing acute abdomen. Excision of the ischemic omentum is the proper treatment for omental torsion.

A case series of 46 appendectomies during pregnancy.

OBJECTIVE: Among appendicitis patients pregnant ones occupy only a small proportion. Still there are difficulties in the diagnosis and management of the acute appendicitis in pregnant population. We tried to find answers to these difficulties with our acute appendicitis cases in pregnant patients. STUDY DESIGN: This study involved 46 pregnant patients who received an operation following diagnosis of acute appendicitis in our clinic from 2006 to 2009. Data were collected retrospectively from medical records. Age, time delay to diagnosis, leukocyte count (WBC), gestational age, gestational history, morbidity-mortality and pathology results were evaluated. RESULTS: The mean age of patients, gestational age and number of prior pregnancies were 26, 21 and 2.6, respectively. The amount of time spent in the hospital, from presentation of first symptom to admission, was approximately 40 hours (range 6-120). The mean time from admission to operation was 5.89 (range 1-32) hours. The perforation rate among our cases was 21%. The negative appendectomy rate was 13%. The perforation rate was associated with advanced gestational age and delayed admission to the hospital (p ≤ 0.001 and p = 0.027, respectively). CONCLUSION: The diagnosis of appendicitis in pregnancy is difficult, and the perforation rate is high. Particularly in term pregnancies, we recommend performing appendectomy immediately after cesarean section.

Internal iliac artery ligation for severe postpartum hemorrhage and severe hemorrhage after postpartum hysterectomy.

AIM: The aim of this study was to evaluate the effect of internal iliac artery (IIA) ligation performed for severe postpartum hemorrhage (PPH). METHODS: Thirty-three women who underwent IIA ligation to control PPH in a tertiary referral center between June 2007 and May 2009 were included in this retrospective analysis. IIA ligation was performed as the primary surgical intervention or to control bleeding following hysterectomy. RESULTS: The 33 women underwent IIA ligation due to uterine atony (n = 22), placenta previa accreta/increta/percreta (n = 5), uterine rupture (n = 4), and placental abruption (n = 2). Twenty-four women underwent IIA ligation as the primary surgical intervention. IIA ligation resulted in control of bleeding in 18/24 women (75%), and only 6/24 women (25%) showed unsuccessful management of bleeding with IIA ligation. In the six women for whom the bleeding was not controlled with IIA ligation, hysterectomy was urgently performed before closure of the abdomen. After obtaining adequate hemostasis with IIA ligation, no women required relaparotomy in the postoperative period. Nine women with persistent bleeding following hysterectomy were also treated with IIA ligation. In our study, there were no intraoperative or postoperative complications related to the procedure. CONCLUSION: IIA ligation may be an effective and safe treatment option to arrest severe PPH. This procedure may also be useful to arrest persistent hemorrhage after hysterectomy. Increased understanding of the retroperitoneal anatomy is needed to reduce the risk of intraoperative and postoperative serious complications.

Synergistic effects of hyperbaric oxygen and granulocytecolony stimulating factor on postoperative adhesion formation in a rat cecal abrasion model.

PURPOSE: We investigated the synergistic effect of hyperbaric oxygen (HBO) and granulocyte-colony stimulating factor (G-CSF) on adhesion formation in rats. METHODS: 40 adult male Sprague-Dawley rats (250-350 g) were divided into 4 groups. In group-1, no further management was undertaken. Group-2 received HBO therapy, group-3 was treated with 50 ug/kg subcutaneous G-CSF once daily for 7 days following laparatomy and cecal abrasion and group-4 was given both G-CSF and HBO therapies. On the 7th day, all rats were sacrificed and adhesions were scored. Tissue samples from adhesions and peritonea and cecum wall were examined both pathologically and biochemically for tissue hydroxyproline content. RESULTS: No mortality occurred in study groups. When the groups were evaluated according to the adhesion numbers and grades, there was a statistically significant difference between the control and groups 3 and 4 (P < 0.001). There was no statistically significant difference between groups 1 and 2 (p > 0.05). HBO + G-CSF group was significantly different from control, HBO and G-CSF groups, regarding hydroxyproline contents (p = 0.005). Inflammation and fibrosis did not differ significantly among the groups (p = 0.248), (p = 0.213). CONCLUSION: HBO treatment could not reduce the adhesion formation alone. Combined use of HBO and G-CSF, has a markedly preventive effect on postoperative adhesion formation (Tab. 1, Fig. 2, Ref. 57).

The antioxidant role of oral administration of garlic oil on renal ischemia-reperfusion injury.

AIM: In this study we examined the effect of oral application of garlic form [garlic oil (GO)] on rats after renal ischemia-reperfusion (I/R) injury. MATERIALS AND METHODS: Forty male Wistar albino rats were divided into four groups: control, sham-operated, I/R, and I/R+GO. GO was diluted in water and administered by oral intubation three times each week for 6 weeks. All rats except sham-operated underwent 45 min of bilateral renal ischemia followed by 6 hr of reperfusion. Blood samples and kidney tissues were harvested from the rats, and then rats were killed. Serum urea, creatinine, and cystatin C levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), nitrite oxide (NO), and protein carbonyl (PC) levels in kidney tissue and blood were measured. In addition, kidney tissue histopathology was evaluated. RESULTS: The serum urea, creatinine, and cystatin C levels were significantly higher in I/R group compared to I/R+GO group (p<0.01). The serum and tissue antioxidant markers (TAC, CAT) were significantly lower in I/R group than I/R+GO group (p<0.01). The serum oxidant markers (TOS, MPO, NO, and PC) were significantly higher in I/R group than I/R+GO group (p<0.01). Also oral application of GO was effective in decreasing of tubular necrosis score. CONCLUSION: Based on the present data, we conclude that increased antioxidants and decreased oxidants modulated by oral application of GO attenuated the renal I/R injury.

Protective effects of Nigella sativa on intestinal ischemia-reperfusion injury in rats.

BACKGROUND: In previous studies, it has been demonstrated that Nigella Sativa (NS) has protective effects against ischemia reperfusion injury on various organs. However, its protective effects on intestinal tissue against ischemia reperfusion injury are unclear. We aimed to determine whether NS prevents intestinal ischemia-reperfusion injury in rats. MATERIALS AND METHODS: Thirty rats were divided into three groups as sham (group 1), control (group 2), and NS-treatment group (group 3). All rats underwent intestinal ischemia for 60 min followed by a 60-min period of reperfusion. Rats were intraperitoneally infused only 0.9% saline solutions in group 2. Rats in the group 3 received NS (0,2 mL/kg) intraperitoneally, before ischemia and before reperfusion. Total antioxidant capacity (TAC), catalase (CAT), total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in ileum tissue were measured. Also, ileum tissue histopathology was evaluated by a light microscope. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in group 2 (p <.01). TAC and CAT activity levels in ileum tissue were significantly higher in group 3 than in group 2. TOS, OSI, and MPO in ileum tissue were significantly lower in group 3 than group 2 (p <.05 for TOS and MPO; p < .01 for OSI). Histological tissue damage was milder in the NS treatment group than in the control group. CONCLUSION: Our results suggest that NS treatment protected the rat's intestinal tissue against intestinal ischemia-reperfusion injury.

Protective effects of Nigella sativa against ischemia-reperfusion injury of kidneys.

BACKGROUND: Ischemia-reperfusion, commonly seen in the fields of trauma surgery and renal transplantation, is a major cause of acute kidney injury and is associated with significant morbidity and mortality. The protective effects of Nigella sativa against ischemia-perfusion damage to various organs have been previously documented. However, its protective effects on kidney tissue against ischemia-reperfusion injury are unclear. In this study, we aimed to examine the effect of Nigella sativa in modulating inflammation and apoptosis after renal I/R injury. MATERIALS AND METHODS: Thirty male Wistar-albino rats were divided into three groups: sham-operated, ischemia-reperfusion, and ischemia-reperfusion + Nigella sativa. Rats in the third group were given Nigella sativa 6 h prior to ischemia-reperfusion and at the beginning of reperfusion. All rats except those in the sham-operated group underwent 45 min of bilateral renal ischemia followed by 45 min of reperfusion. Blood samples and liver tissues were harvested from the rats, and then rats were sacrificed. Serum urea and creatinine levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidant status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in kidney tissue and blood were measured. Kidney tissue histopathology was also evaluated. Results. Nigella sativa was effective in reducing serum urea and creatinine levels as well as decreasing the tubular necrosis score. Nigella sativa treatment significantly reduced OSI and TOS levels and increased TAC levels in both kidney tissue and blood. CONCLUSION: The observed differences seem to demonstrate the protective effect of Nigella sativa against renal I/R injury in rat kidneys.

The effect of caffeic acid phenethyl ester (CAPE) against cholestatic liver injury in rats.

OBJECTIVES: Caffeic acid phenethyl ester (CAPE) has been subjected to considerable investigations that have revealed its antioxidant and anti-inflammatory activities in different conditions. But there is not a previous investigation about its effect on cholestatic liver injury. The aim of this study was to investigate the effect of CAPE in rat liver against cholestatic liver injury induced by bile duct ligation. METHODS: Swiss-albino rats were recruited in the study as follows; Group 1 rats subjected to simple laparotomy known as the sham group; Group 2 rats subjected to bile duct ligation (BDL); Group 3 bile duct ligated rats treated with CAPE. The third group received CAPE (10 micromol/kg) intraperitoneally daily throughout 14 d. RESULTS: Data showed a decrease in gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase levels (ALT) of the CAPE treated rats, compared with BDL group (P < 0.001, P < 0.01, and P < 0.02, respectively). In the CAPE treated rats, tissue levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were significantly lower than that of the BDL group (P < 0.001). The levels of glutathione (GSH) in CAPE treated rats were significantly higher than that of BDL group (P < 0.001). In CAPE treated group, the levels of interleukin-1alpha (IL-1alpha) and interleukin-6 (IL-6) were significantly lower than that of BDL group (P < 0.03, P < 0.02, respectively). Administration of CAPE in the rats with biliary obstruction resulted in inhibition of necro-inflammation. CONCLUSION: These results suggest that treatment of CAPE maintains antioxidant defenses, reduces oxidative liver injury, cytokine damage, and necro-inflammation in bile duct ligated rats. Thus, CAPE seems to be a promising agent for the attenuation of cholestatic liver injury.

The effects of Nigella sativa on bile duct ligation induced-liver injury in rats.

Nigella sativa (NS) has been shown to have antioxidant and antiinflammatory activities in different conditions. The goal of this study was to evaluate the effects of NS on cholestatic liver injury in rats. Thirty rats were recruited in the study as follows: Group 1, Bile duct ligation (BDL) (n = 10); Group 2, BDL plus NS (n = 10); and Group 3, Sham (n = 10). Bile duct ligated group received 0.2 mL kg(-1) dose of NS intraperitoneally daily throughout 14 days. Liver damage and cholestasis were determined by the biochemical and the pathologic examination. Data showed a decrease in gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activities of the NS treated rats when compared with BDL group (p < 0.001 for GGT and p < 0.05 for others). The NS treated rats' tissue levels of total oxidant status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) were significantly lower than that of the BDL group (p < 0.01 for all). Increases in total antioxidant capacity (TAC) and catalase (CAT) levels were statistically significant in the NS treated rats compared to BDL group (p < 0.01 for both). On the other hand, administration of NS in the rats with biliary obstruction resulted in inhibition of necro-inflammation. These results indicate that NS exerts a therapeutic effect on cholestatic liver injury in bile duct ligated rats possibly through attenuation of enhanced neutrophil infiltration and oxidative stress in the liver tissue.

Purified micronized flavonoid fraction ameliorates the injury of spleen and ileum secondary to hepatic ischemia-reperfusion in rats.

BACKGROUND: Flavonoids have been subjected to considerable investigations due to their antioxidant and anti-inflammatory properties. Yet the effects of flavonoids on the ileum and spleen against hepatic ischemia-reperfusion injury have so far not been addressed. AIMS: We aimed to investigate whether micronized purified flavonoid fraction (MPFF) protects the ileum and spleen against hepatic ischemia-reperfusion injury. METHODS: Rats were subjected to hepatic ischemia by clamping the hilar area of the rats for 60 min, followed by 60 min of reperfusion. Rats in the treatment group were treated with MPFF (80 mg/kg/day) by gavage for 3 days before surgery, 30 min prior to ischemia and just before the reperfusion. After the reperfusion period, all rats were sacrificed. Ileal and splenic tissues were taken for histological evaluation and determination of the total antioxidant capacity (TAC), catalase, total oxidant status (TOS), oxidative stress index (OSI) and myeloperoxidase (MPO) levels. RESULTS: TAC levels in the splenic tissue and intestinal tissue were significantly higher in the treatment group than in the control group (P < 0.01 for both). TOS, OSI, and MPO in splenic tissue (P < 0.01, P < 0.05, and P < 0.05, respectively) and intestinal tissue (P < 0.01, P < 0.01, and P < 0.001, respectively) were significantly lower in the treatment group than in the control group. Histological tissue damage of intestinal tissue was milder in the treatment group than in the control group. CONCLUSION: The results of this study indicated that MPFF pretreatment significantly limited the injury to the small intestine and spleen induced by hepatic ischemia-reperfusion in rats.

A rare cause of difficulty with sexual intercourse: large retroperitoneal leiomyoma.

INTRODUCTION: The prevalence of sexual dysfunction is high among women; however, sexual dysfunction secondary to anatomical deformity in women is rare. In addition, primary retroperitoneal leiomyomas are very rare clinical conditions. AIM: To present a case with sexual dysfunction secondary to anatomical deformity. METHODS: In this article, we report the case of a large retroperitoneal leiomyoma causing sexual dysfunction. RESULTS: After the surgical removal of the large retroperitoneal mass, previous intercourse difficulties had been resolved. CONCLUSIONS: Retroperitoneal tumors may obstruct the vagina by congesting the pelvic area and may be considered as a possible cause of female sexual dysfunction.

Protective effects of resveratrol on small intestines against intestinal ischemia-reperfusion injury in rats.

BACKGROUND AND AIM: The aim of this study was to determine whether resveratrol could prevent intestinal tissue injury induced by ischemia-reperfusion (I/R). METHODS: Intestinal I/R was induced in rats' intestines by 60-min occlusion of the superior mesenteric artery, followed by a 60-min reperfusion. Thirty rats were divided into three groups as follows: sham (group 1), control (group 2), and the treatment groups (group 3). The rats in the treatment group received resveratrol both before ischemia and before reperfusion. In all groups, serum aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels were determined. Total antioxidant capacity (TAC), catalase, total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in the intestinal tissue were measured. Intestinal tissue histopathology was also evaluated by light microscopy. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in group 2 (P < 0.05). TAC in the intestinal tissue was significantly higher in group 3 than in group 2 (P < 0.05). TOS, OSI, and MPO in the intestinal tissue were significantly lower in group 3 than in group 2 (P < 0.05 for all). Histological tissue damage was milder in the resveratrol treatment group than in the control group. CONCLUSIONS: The results of this study indicated that resveratrol treatment limits the oxidative injury of the small intestine induced by I/R in rats. However, more precise investigations are required to evaluate the antioxidative effect of resveratrol on small intestine tissue damage in clinical and experimental models.

The handmade endoloop technique. A simple and cheap technique for laparoscopic appendectomy.

OBJECTIVE: To compare 2 laparoscopic appendectomy techniques. METHODS: We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test. RESULTS: The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups. CONCLUSION: This procedure is simple, safe, and cheap.

Nigella sativa relieves the deleterious effects of ischemia reperfusion injury on liver.

AIM: To determine whether Nigella sativa prevents hepatic ischemia-reperfusion injury to the liver. METHODS: Thirty rats were divided into three groups as sham (Group 1), control (Group 2), and Nigella sativa (NS) treatment group (Group 3). All rats underwent hepatic ischemia for 45 min followed by 60 min period of reperfusion. Rats were intraperitoneally infused with only 0.9% saline solution in group 2. Rats in group 3 received NS (0.2 mL/kg) intraperitoneally, before ischemia and before reperfusion. Blood samples and liver tissues were harvested from the rats, and then the rats were sacrificed. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidative status (TOS), oxidative stress index (OSI) and myeloperoxidase (MPO) in hepatic tissue were measured. Also liver tissue histopathology was evaluated by light microscopy. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in the group 2. TAC in liver tissue was significantly higher in group 3 than in group 2. TOS, OSI and MPO in hepatic tissue were significantly lower in group 3 than the group 2. Histological tissue damage was milder in the NS treatment group than that in the control group. CONCLUSION: Our results suggest that Nigella sativa treatment protects the rat liver against to hepatic ischemia-reperfusion injury.