Comparison of the Effects of Surgical Smoke on the Air Quality and on the Physical Symptoms of Operating Room Staff.

BACKGROUND: Surgical smoke can be a hazard because e it contains toxic gases with carcinogenic effects that may threaten health. This study aims to determine the effect of surgical smoke containing toxic chemicals on indoor air quality and examine employees' physical symptoms in the operating room. METHOD: The study was conducted in the operating room between June 2020 and July 2020. In the study, 45 air samples were taken before, during, and after surgery using the active sampling method. Nineteen employees working in the operating room were asked about their physical complaints and their throat cultures were taken before and after surgery. These results were compared with those of the employees working in internal units. RESULTS: The Total Volatile Organic Compounds value at the time of surgery was significantly higher (p ≤ 0.05). Benzene concentrations remained constantly high (p ≤ 0.05) throughout the surgery, exceeding the limit values. Other VOCs (Volatile Organic Compounds) were significantly higher during surgery and remained below the limit values (p ≤ 0.05). When compared in terms of open and laparoscopic surgery, no difference between VOC concentrations was observed (p ≤ 0.05). The physical symptoms of the surgical team increased during the operation, and they experienced more complaints of tearing, burning in the eyes, hair odor, nausea, and cough than those working in the internal units (e.g., internal medicine, dermatology; (p ≤ 0.05). CONCLUSIONS: Surgical smoke was an important contaminant for indoor air quality in the operating room.

Evaluation of the American College of Radiology Thyroid Imaging, Reporting and Data System (Thyroid imaging reporting) scoring in thyroid Bethesda category on atypia and follicular lesion of uncertain significance patients.

OBJECTIVE: Treatment and follow-up are controversial in patients whose thyroid fine needle aspiration biopsy (FNAB) is reported as atypia of undetermined significance and follicular lesion of uncertain significance (AUS/FLUS). We aimed the efficacy of the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) in preventing unnecessary thyroidectomies in patients with FNA cytology results as AUS/FLUS. METHODS: In Bolu Abant Izzet Baysal University General Surgery Clinic, case series between 2017 and 2020 were analyzed with thyroid operated. Grouping was made according to the result of postoperative pathology: those with benign results after postoperative pathology were classified as Group 1, and those with malignant results after postoperative pathology were classified as Group 2. RESULTS: As a result, 66 patients were found to be AUS/FLUS. A total of 28.8% of AUS/FLUS patients have been determined with cancer. In the statistical analysis of the ACR TI-RADS score between the groups, the ACR TI-RADS score in Group 1 patients (3.36) (SD 0.87) was significantly lower than that in Group 2 patients (4.11) (SD 1.04) (p=0.003). The distribution of the ACR TI-RADS scores of the patients in Group 2 was TR2: 2 (15.4%) patients, TR3: 3 (25%) patients, TR4: 5 (16.1%), TR5: 9 (90%) patients, respectively. CONCLUSION: The ACR TI-RADS score was statistically significant in predicting malignancy in AUS/FLUS patients whose follow-ups and treatments are controversial, and the ACR TI-RADS has a limited role in preventing unnecessary thyroidectomies in patients with AUS/FLUS.

Is appendectomy a simple surgical procedure?

OBJETIVO: La apendicitis aguda es uno de los procedimientos quirúrgicos más aplicados en todo el mundo. Una de las complicaciones de la apendicectomía es la apendicitis del muñón. El diagnóstico de apendicitis del muñón suele retrasarse. MÉTODOS: En nuestro estudio recopilamos casos de apendicitis del muñón tras apendicectomía. Todos los casos con apendicectomía abierta y laparoscópica fueron incluidos en nuestro estudio. RESULTADOS: Entre 2008 y 2020 se examinaron 5620 pacientes apendicectomizados que fueron operados en la clínica de cirugía general. Se realizó apendicectomía en 5 pacientes por apendicitis del muñón. Uno de los pacientes con apendicitis del muñón presentó síntomas de peritonitis generalizada, otro con síntomas de íleo, el otro con síntomas de hernia de incisión encarcelada en la incisión de Mc Burney y los otros dos pacientes con síntomas de apendicitis aguda. CONCLUSIONES: Como se desprende de nuestro estudio, si bien la apendicectomía es el procedimiento quirúrgico más común y fácil de ver en la práctica quirúrgica general, es un procedimiento que aumenta la morbilidad como vemos en los pacientes con apendicitis del muñón. La tomografía abdominal parece ser el estándar de oro en el diagnóstico de la apendicitis del muñón. Los cirujanos definitivamente deben sospechar apendicitis del muñón en pacientes cuyos síntomas han mejorado, incluso con cicatrices de apendicectomía abierta. OBJECTIVE: Acute appendicitis is among the most applied surgical procedures around the world. One of the complications of appendectomy is stump appendicitis. The diagnosis of stump appendicitis is usually delayed. MATERIAL AND METHOD: In our study, we compiled cases with stump appendicitis after appendectomy. All cases with open and laparoscopic appendectomy were included in our study. RESULTS: Between 2008 and 2020, 5620 appendectomy patients who were operated in the general surgery clinic were examined. Appendectomy was performed in five patients due to stump appendicitis. One of the patients with stump appendicitis presented with symptoms of generalized peritonitis, another with symptoms of ileus, the other with symptoms of incarcerated incision hernia at the McBurney incision, and the other two patients with symptoms of acute appendicitis. CONCLUSION: As it can be understood from our study, although appendectomy is the most common and easily seen surgical procedure in general surgical practice, it is a procedure that increases morbidity as we see in patients with stump appendicitis. Abdominal tomography appears to be the gold standard in diagnosis in stump appendicitis. Surgeons should definitely suspect stump appendicitis in patients whose symptoms have improved, even with open appendectomy scarring.

Henoch-Schönlein Purpura Presenting with Acute Abdomen.

Henoch-Schönlein Purpura (HSP) is an autoimmune, systemic, non-granulomatous vasculitis characterised by self-limiting clinical course, and leukocytoclastic vasculitis of small vessels. Deposition of immune complexes that contain IgA is the hallmark of vascular involvement. Adults with HSP have a higher incidence of complications and death. The most common gastrointestinal (GI) symptom of HSP is abdominal pain. Vasculitis-related colitis, causing extensive lower GI hemorrhage, is uncommon in the course of HSP, which increases the risk of renal involvement. Here, we present two cases of HSP with GI involvement. In the first case, surgery was performed.  Whereas, the other patient was treated medically due to the experience gained from the first case. The HSP has no specific treatment. Most of the cases are mild and need only supportive care due to its self-limiting nature. Although corticosteroids do not prevent recurrences, evidence in literature suggests that these are beneficial in resolution of the arthritis and abdominal pain. Aggressive therapy with corticosteroids or cyclophosphamide is not successful in reducing renal damage, except in patients with crescentic nephritis. Key Words: Henoch-Schönlein purpura, Gastrointestinal complications, Steroids, Surgery.

Ibuprofen increases the serum Omentin levels in rats after abdominal surgery.

AIMS Omentin is an adipokine primarily produced by visceral adipose tissue and its reduced levels have been shown to be associate with worse metabolic outcomes. We aimed to study the effects of preoperative ibuprofen on postoperative omentin levels in rats after surgery. METHODS Forty-eight albino Wistar rats, 6 in each of 8 groups according to the surgical procedure (laparotomy, laparotomy plus ibuprofen (IBU), nephrectomy, nephrectomy plus IBU, hepatectomy, hepatectomy plus IBU, splenectomy and splenectomy plus IBU). The Omentin levels of the groups were postoperatively analyzed. RESULTS The mean omentin was significantly higher in the laparotomy plus IBU group compared to the laparotomy group (p<0.001). Mean Omentin was significantly higher in the hepatectomy plus IBU group compared to the hepatectomy group (p=0.01). Mean Omentin was significantly higher in the nephrectomy plus IBU group compared to the nephrectomy group (p=0.001). CONCLUSION We suggest that preoperative ibuprofen may enhance circulating levels of Omentin, which has beneficial effects in trauma and inflammation settings in subjects that undergo minor or major abdominal surgery.

Prediction of Lymph Node Metastasis in Colon Cancer via Platelet to Lymphocyte Ratio and Platelet Count.

OBJECTIVE: To investigate the value of preoperative blood tests in predicting lymph node metastasis in colon cancer patients undergoing surgery. STUDY DESIGN: Obervational study. PLACE AND DURATION OF STUDY: General Surgery Department, Bolu Abant Izzet Baysal University Medicine School, Turkey, between December 2012 and December 2018. METHODOLOGY: In 171 colon cancer patients, preoperative inflammatory markers such as albumin, C-reactive protein (CRP), platelet, neutrophil-to-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) counts were determined. RESULTS: The present study albumin, CRP and NLR values were also not significantly different between the groups. PLR (p=0.008) and PLT (p=0.039) were significantly different between the lymph node groups. ROC analysis was performed for PLT and PLR for the prediction of lymph node metastasis (Group 2 and 3). Accuracy for PLT was 0.623 and accuracy for PLR was 0.65. A PLT value >321.5 was found to be 63.7% sensitive and 68.6% specific in predicting lymph node metastasis. A PLR value >155.81 was 70% sensitive and 41% specific for predicting lymph node metastasis. CONCLUSION: The platelet counts and PLR values are important in predicting lymph node metastasis in colon cancer, preoperatively. Platelet and PLR values may be more specific and sensitive in predicting preoperative lymph node metastasis in colon cancer patients.

Ibuprofen increases the serum Omentin levels in rats after abdominal surgery

SUMMARY AIMS Omentin is an adipokine primarily produced by visceral adipose tissue and its reduced levels have been shown to be associate with worse metabolic outcomes. We aimed to study the effects of preoperative ibuprofen on postoperative omentin levels in rats after surgery. METHODS Forty-eight albino Wistar rats, 6 in each of 8 groups according to the surgical procedure (laparotomy, laparotomy plus ibuprofen (IBU), nephrectomy, nephrectomy plus IBU, hepatectomy, hepatectomy plus IBU, splenectomy and splenectomy plus IBU). The Omentin levels of the groups were postoperatively analyzed. RESULTS The mean omentin was significantly higher in the laparotomy plus IBU group compared to the laparotomy group (p<0.001). Mean Omentin was significantly higher in the hepatectomy plus IBU group compared to the hepatectomy group (p=0.01). Mean Omentin was significantly higher in the nephrectomy plus IBU group compared to the nephrectomy group (p=0.001). CONCLUSION We suggest that preoperative ibuprofen may enhance circulating levels of Omentin, which has beneficial effects in trauma and inflammation settings in subjects that undergo minor or major abdominal surgery.

RESUMO OBJETIVOS A omentina é uma adipocina produzida principalmente pelo tecido adiposo visceral e níveis reduzidos dela foram associados a piores desfechos metabólicos. Nosso objetivo foi estudar os efeitos do uso pré-operatório do ibuprofeno nos níveis pós-operatórios da omentina em ratos. METODOLOGIA Quarenta e oito ratos Wistar albinos foram divididos em 8 grupos (6 em cada), de acordo com o procedimento cirúrgico: laparotomia, laparotomia e ibuprofeno (IBU), nefrectomia, nefrectomia e IBU, hepatectomia, hepatectomia e IBU, esplenectomia, e esplenectomia e IBU. Os níveis de omentina dos grupos foram analisados após a cirurgia. RESULTADOS A omentina média foi significativamente maior no grupo de laparotomia e IBU do que no grupo de laparotomia (p<0,001). A omentina média foi significativamente maior no grupo de hepatectomia e IBU do que no grupo de hepatectomia (p = 0,01). A omentina média foi significativamente maior no grupo de nefrectomia e IBU do que no grupo de nefrectomia (p = 0,001). CONCLUSÃO Sugerimos que o uso pré-operatório de ibuprofeno pode aumentar os níveis circulantes de omentina, que têm efeitos benéficos em um contexto de trauma e inflamação em indivíduos submetidos cirurgia abdominal.

The relationship between tumor budding and survival in colorectal carcinomas

SUMMARY OBJECTIVE Tumor budding is a parameter that is increasingly understood in colorectal carcinomas. We aimed to investigate the relationship between tumor budding, prognostic factors, and survival METHODS A total of 185 patients who had undergone colorectal surgery were observed. Tumor budding, the tumor budding score, and the relationship between these and prognostic factors, and survival investigated. RESULTS Tumor budding was found in 91 (49.2%) cases. The relationship between the tumor budding score and histological grade, lymphovascular invasion, perineural invasion, pathological lymph node stage, and mortality rates were significant. CONCLUSION In our study, the relationship between tumor budding and survival is very strong. Considering these findings and the literature, the prognostic significance of tumor budding becomes clear and should be stated in pathology reports.

RESUMO OBJETIVO Brotamento de tumor é um parâmetro que é cada vez mais conhecido em carcinomas colorretais. Nosso objetivo foi investigar a relação entre brotamento tumoral e fatores prognósticos e sobrevida. MÉTODOS Um total de 240 pacientes observados, submetidos à cirurgia colorretal. Brotamento de tumor, escore de brotamento tumoral e a relação entre estes e fatores prognósticos, sobrevida investigada. RESULTADOS Brotamento de tumores foi encontrado em 91 (49,2%) casos. A relação entre o escore de brotamento tumoral e o grau histológico, invasão linfovascular, invasão perineural, estadiamento linfonodal patológico e taxas de mortalidade foram significativas. CONCLUSÃO Em nosso estudo, a relação entre brotamento tumoral e sobrevida é muito forte. Em conjunto, todos esses achados e literatura são avaliados simultaneamente, o significado prognóstico da brotação do tumor é claramente visto e deve ser indicado nos relatórios de patologia.

Neutrophil to Lymphocyte Ratio is Useful in Differentiation of Malign and Benign Thyroid Nodules.

OBJECTIVE: Significant amount of thyroid nodules are malignant. Inflammation plays crucial role in the pathogenesis of many disorders, including cancer. Neutrophil to lymphocyte ratio (NLR), has been suggested as an index of inflammatory response and association between increased NLR and cancer has also been reported. In this retrospective analysis, we aimed to study NLR levels in patients with malign and benign thyroid nodules and healthy control subjects. METHODS: The patients who underwent surgery for nodular goiter in general surgery clinics of our university hospital between June 2012 and June 2015 and 68 healthy volunteers were included. Patients with thyroid nodules divided into malign or benign nodule groups according to the pathology report. Thyroid carcinomas other than micropapillary tumor were excluded. Preoperative hemogram parameters of these groups were compared. RESULTS: Mean NLR of malign nodule group (2.1±0.9%) was significantly higher than both those in benign nodule (1.7±0.9%) and control groups (1.7±0.6%). CONCLUSION: We suggest that elevated NLR in patients with thyroid nodules in preoperative period may be an indicator of underlying malign nodular disease. Increased NLR in such patients should encourage physician to perform cancer screening in thyroid gland.

Detection Rate of Thyroid Papillary Micro-carcinoma in Multinodular Goiter Surgery.

OBJECTIVE: To determine the frequency of papillary thyroid micro-carcinoma (PTMC) in multinodular goiter (MNG) surgery, as well as in opposite thyroid lobule of the dominant nodule. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: General Surgery Department, Abant Izzet Baysal University Hospital, between January 2010 and December 2016. METHODOLOGY: The data of 1300 patients who underwent thyroidectomy analyzed. Patients with single nodule in preoperative sonography, and patients with malignancy or suspected malignancy in fine needle aspiration cytology were excluded. PTMC was labelled as less than 10 mm in diameter. RESULTS: After exclusion of such patients, 1,197 subjects with benign MNG were included in the study. There were 1,134 patients in benign group and 63 subjects in PTMC group, according to the postoperative pathology results. In PTMC group, 53 (84%) of subjects had one tumor and 10 (16%) has more than one cancerous nodules. Thirty-six (57%) of cancers in PTMC group were right sided and 27 (43%) were left sided. Cancer and dominant nodule were in the same thyroid lobe in 62% (n = 39) subjects in PTMC group. However, 24 subjects had cancer in the lobe opposite to the largest nodule. CONCLUSION: Total bilateral thyroidectomy should be preferred in MNG surgery due to high probability of multicentric disease.

Effects of Bispectral Index-controlled Use of Magnesium on Propofol Consumption and Sedation Level in Patients Undergoing Colonoscopy.

OBJECTIVE: The aim of this study is to investigate the effects of bispectral index-controlled use of magnesium on propofol consumption, periprocedural hemodynamic response and patient comfort. MATERIAL: A total of 60 patients were enrolled in the study. In Group 1 (magnesium), a single dose 50 mg/kg magnesium sulfate diluted with 100 mL 0.9% NaCl was administered 10 minutes before the beginning of the procedure. Initially bolus dose of 0.5 mg/kg propofol was applied. The maintenance dose of propofol was 60 mcg/kg/min. During the procedure, the propofol infusion was increased by titration until the bispectral index (BIS) value of 70 was achieved. In Group 2 (saline), 100 ml 0.9% NaCl was administered 10 minutes before the beginning of the procedure. The bolus and maintenance doses of propofol, and target BIS values were the same as those in Group 1. RESULTS: When BIS values were compared between the groups, the initial BIS values in the magnesium group (Group 1) were significantly higher than those of the saline group (Group 2) (p<0.05). The time to reach BIS 70 was significantly shorter in the magnesium group (p<0.05). Propofol consumption was greater in Group 2 than in Group 1 (p<0.05). The time to reach BIS 70 was significantly shorter in Group 1 (p<0.05). No significant difference was found between the groups in terms of patient- and endoscopist-satisfaction (p<0.05). CONCLUSION: The use of magnesium in addition to propofol may be an efficient and reliable option to reduce the drug consumption during colonoscopic interventions.

4-(3,4-dihydroxybenzoyloxymethyl)phenyl-O-ß-D-glucopyranoside effect in liver regeneration.

Following an injury or resection, the mammalian liver has the capacity to regain its former volume and functioning by restoring itself. Studies have demonstrated that antioxidants play a role in hepatic regeneration. This study investigated the effect of 4-(3,4-dihydroxybenzoyloxymethyl) phenyl-O-ß-D-glucopyranoside (PG) obtained from Origanum micranthum on liver regeneration. Sixty Wistar Albino rats were used. In the sham-operated group, a midline abdominal laparotomy was performed without hepatectomy. In the partial hepatectomy (PHx) group, the median and left lateral lobes were removed. Rats in the PHx group received 20 mg/kg/day PG intraperitoneally before being sacrificed at 24, 48, and 72 hrs, and 7 days later. Liver tissues were collected for immunohistochemical analysis and electron microscopic evaluation. We found an increase in mitotic index, and the numbers of Ki-67 stained hepatocytes in all PHx early stage groups (24 hr, 48hr, 72 hr), but not in 7-day groups. The regeneration mediators eNOS, iNOS, TNF-α and NF-κB were shown to increase in PHx groups. This increase was more prominent dependening on time. In the PHx treatment (PHx+PG) groups, while eNOS was still high, iNOS, TNF-α and NF-κB had decreased. The apoptotic index was markedly high in the PHx groups; this was prevented by PG treatment. These findings were supported by the ultrastructural results. Our findings indicate that PG supports liver regeneration, hepatocyte proliferation, reduced liver damage, and inflammatory mediators following PHx.

MEAN PLATELET VOLUME: AN OVERLOOKED HERALD OF MALIGNANT THYROID NODULES.

Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.

The relationship between tumor budding and survival in colorectal carcinomas.

OBJECTIVE: Tumor budding is a parameter that is increasingly understood in colorectal carcinomas. We aimed to investigate the relationship between tumor budding, prognostic factors, and survival. METHODS: A total of 185 patients who had undergone colorectal surgery were observed. Tumor budding, the tumor budding score, and the relationship between these and prognostic factors, and survival investigated. RESULTS: Tumor budding was found in 91 (49.2%) cases. The relationship between the tumor budding score and histological grade, lymphovascular invasion, perineural invasion, pathological lymph node stage, and mortality rates were significant. CONCLUSION: In our study, the relationship between tumor budding and survival is very strong. Considering these findings and the literature, the prognostic significance of tumor budding becomes clear and should be stated in pathology reports.

Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis

Summary Objective: Hashimoto's thyroiditis (HT) is an autoimmune inflammatory disorder. The purpose of this study was to determine the neutrophil-to-lymphocyte ratio (NLR), a novel marker of inflammation, in patients with HT and to compare these values with those from healthy subjects. Method: A total of 154 participants were included in the study, 90 HT patients and 64 healthy volunteers. Retrospectively, demographic and laboratory data of the subjects were obtained from our institution's database. Patients with active infection, diabetes mellitus, malignancy, other chronic inflammatory diseases, hematologic disorders and patients on aspirin or steroid treatment were excluded from the study. Values for complete blood count (CBC) and serum laboratory parameters of HT patients were the baseline values obtained at the time of HT diagnosis. Control subjects consisted of healthy volunteers who visited our institution for a routine check-up. Results: Age, gender and CBC parameters were not different between the HT group and the control group; however, the NLR of HT group (2.1 [1.3-5.8]) was significantly higher than the control group (1.9 [0.6-3.3]), p=0.04. Conclusion: Increased NLR may be useful as an indicator of the presence of HT, especially in complicated cases. NLR is inexpensive and easy to determine. Larger, prospective studies are required to determine its usefulness in assessing diagnostic potential and treatment outcomes in HT patients.

Could Red Cell Distribution Width be a Marker of Thyroid Cancer?

OBJECTIVE: To study red cell distribution width (RDW) values, a novel inflammatory marker in routine hemogram, of patients with benign or malignant thyroid nodules and to compare with healthy population. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Abant Izzet Baysal University Hospital, Bolu, Turkey, from November 2015 and February 2017. METHODOLOGY: The hemogram values of patients undergone thyroid surgery for thyroid nodule between November 2015 and February 2017 were retrospectively analyzed, and compared to those in healthy subjects. Subjects with infectious or inflammatory diseases were excluded. Patients' characteristics and laboratory data were obtained from institutional computerized database. Preoperative hemogram values of thyroid nodule patients were recorded. One-way ANOVAand Kruskal-Wallis tests were performed to compare variables with significance at p<0.05. RESULTS: Median RDW of malignant nodule group was 15.8 (12.9-19.5) and was significantly higher than both of those in benign nodule (15) and control groups (14), (p<0.001). CONCLUSION: Elevated RDW in patients with thyroid nodules in preoperative period should alert the physician for possible malignancy and this cost-effective marker also can help support other modalities (ultrasound scan, and fine needle aspiration biopsy) to distinguish malignant from benign nodules.

Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis.

OBJECTIVE: Hashimoto's thyroiditis (HT) is an autoimmune inflammatory disorder. The purpose of this study was to determine the neutrophil-to-lymphocyte ratio (NLR), a novel marker of inflammation, in patients with HT and to compare these values with those from healthy subjects. METHOD: A total of 154 participants were included in the study, 90 HT patients and 64 healthy volunteers. Retrospectively, demographic and laboratory data of the subjects were obtained from our institution's database. Patients with active infection, diabetes mellitus, malignancy, other chronic inflammatory diseases, hematologic disorders and patients on aspirin or steroid treatment were excluded from the study. Values for complete blood count (CBC) and serum laboratory parameters of HT patients were the baseline values obtained at the time of HT diagnosis. Control subjects consisted of healthy volunteers who visited our institution for a routine check-up. RESULTS: Age, gender and CBC parameters were not different between the HT group and the control group; however, the NLR of HT group (2.1 [1.3-5.8]) was significantly higher than the control group (1.9 [0.6-3.3]), p=0.04. CONCLUSION: Increased NLR may be useful as an indicator of the presence of HT, especially in complicated cases. NLR is inexpensive and easy to determine. Larger, prospective studies are required to determine its usefulness in assessing diagnostic potential and treatment outcomes in HT patients.

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.

Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients.

Liver transplantation (LT) has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome (GS) is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation (LDLT) from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients. Between September 2011 and March 2015, 305 LDLT procedures using right lobe grafts were performed at Atasehir Memorial Hospital, Istanbul, Turkey. Nineteen of 305 LT candidates who had been diagnosed with GS were included in the current study. After a 12-h overnight fast, total and indirect bilirubin levels of donors and recipients were measured. The median follow-up after transplant was 16 months (range 3-36 months). The median age of donors was 25 (range 20-55 yr). Four donors (21%) were female, and 15 donors (89%) were male. The median age of donors was 51 (range 23-68 yr). Eleven recipients (57%) were female, and 8 (43%) were male. The median preoperative total bilirubin level of donors was 1.69 mg/dL (range 1.26-2.43 mg/dL) (normal range <1.2 mg/dL). The median total bilirubin level of donors on postoperative day 7 was 1.04 mg/dL (range 0.71-3.23 mg/dL). As our study has included a large number of donors with GS, it produced reliable evidence that right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients.