The importance of serum intestinal fatty acid-binding protein for the early diagnosis of acute mesenteric ischemia.

BACKGROUND: Acute mesenteric ischemia (AMI), although relatively rare, is an emergency condition with high mortality rates (60-80%) attributed to lack of early diagnosis. The aim of this experimental study was to observe the changes in serum intestinal fatty acid-binding protein (I-FABP) levels over time in the AMI model by ligating superior mesenteric artery (SMA) in rats and to compare with the serum I-FABP levels of the rats in the control group. METHODS: Twenty rats were randomly allocated into two groups as control and ischemia group. The basal serum I-FABP levels were determined. SMA was isolated by laparotomy in all animals. In the ischemia group, SMA was ligated and intestinal ischemia was formed. Blood was taken from each rat in both groups at 30th, 60th, and 90th min to determine the serum I-FABP levels. The blood results were compared between two groups and were also compared by time in each group. RESULTS: In the ischemia group, serum I-FABP levels were significantly higher than the control group at post-operative 30th, 60th, and 90th min (p<0.01). In comparison with pre-operative serum I-FABP levels, remarkable increases were observed statistically at post-operative 30th, 60th, and 90th min in the ischemia group (p<0.01). In contrast, there was no statistically significant difference within the serum I-FABP levels over time in the control group. The increases of serum I-FABP levels in the ischemia group were directly correlated with the time of ischemia. CONCLUSION: Serum I-FABP levels have increased significantly in the intestinal ischemia and these values have risen progressively over time. Serum I-FABP may be a useful and promising biomarker for the early diagnosis of AMI.

Factors affecting mortality in patients with traumatic diaphragmatic injury: An analysis of 92 cases.

BACKGROUND: This study aims to investigate the factors associated with mortality in patients with traumatic diaphragmatic rupture (TDR). METHODS: The records of patients who were operated on at a single hospital with the indication of blunt or penetrating thoracoabdominal injuries between January 2010 and June 2018 and who were perioperatively diagnosed with a diaphragmatic injury were evaluated retrospectively. The details of demographic characteristics, the type and localization of the trauma, presence and number of associated organ injuries, vital signs at admission, time from admission until surgery, type of operation, type of diaphragmatic repair, therapeutic approach, complications and Injury Severity Score (ISS) were analyzed. RESULTS: A total of 92 patients were included in this study. The mortality rate throughout the postoperative period was 15.2%. A penetrating injury was detected in 77.2% of the patients. Associated organ injury was most frequently in the liver, which was significant as a factor that increased mortality (p=0.020). The mortality rate was significantly lower among patients who underwent repair of diaphragmatic rupture when compared with untreated patients (p=0.003). Atelectasis was the most common complication. An ISS ≥24 points in patients with TDR was found to be an independent risk factor associated with mortality (p=0.003). CONCLUSION: Other organs are frequently involved in cases of TDR, and mortality increased significantly in cases with associated liver injury. An ISS of ≥24 was determined to be an independent risk factor associated with mortality. Since the main determinant of mortality was the presence or absence of additional organ injuries, it is important that this should be taken into consideration in these patients.

Evaluation of current therapeutic approach to obstructive and perforated colorectal cancers.

BACKGROUND: Late diagnosis continues to be a significant problem in the treatment of colorectal cancer (CRC). Most cases require emergency surgical intervention due to acute intestinal obstruction or perforation. This retrospective study was formed from an assessment of the clinical presentation, treatment, early results, and survival of patients with CRC undergoing emergency surgery for acute obstruction or perforation. METHODS: Between 2012 and 2017, 612 patients underwent surgery for CRC. In all, 179 patients who required emergency treatment were retrospectively evaluated according to age, gender, significant comorbidities, physiological status, surgical indications, tumor location, tumor stage, perioperative blood transfusion rate, type of surgery, and the length of the operation and hospitalization. RESULTS: In total, 152 (85%) patients had a complete obstruction and 27 (15%) patients had a perforation. A major postoperative complication was identified nearly in half of the patients. The overall mortality rate was 12% (22 patients). Mortality was seen in 12% (18 patients) cases received surgery due to obstruction and in 15% (four patients) cases received surgery due to perforation. Perioperative blood transfusion and a high Acute Physiology and Chronic Health Evaluation II score were independent factors that predicted a major complication. Advanced age and perioperative blood transfusion were statistically independent prognostic factors for mortality. CONCLUSION: Consisted with the findings of studies in the literature, the results of this study also revealed a high perioperative morbidity and mortality rate in patients with CRC who required urgent surgery. Our findings suggest that early detection and treatment of CRC with screening programs can be life-saving.

Outcomes of silver nitrate use in perianal fistula: are perianal fistulas still a nightmare for surgeons?

INTRODUCTION: In this study, we aimed to evaluate outcomes of % 20 silver nitrate (SNS) application in perianal fistula patients. MATERIAL AND METHOD: All patients who received 20 % SNS treatment for intersphincteric and transsphincteric fistulas between January 2017 and December 2017 were included in our study. Patients were invited for control examinations after one week. Patients with continued discharges after single dose of SNS kept receiving solution six more times with one month intervals. Stopping of discharges were considered as finalization of the study. Cases with discharges after 6 episodes of SNS were described as insufficient healing. The patients were grouped according to healing status (healing patients in Group 1, non-healing patients in Group 2) .Gender, age, follow-up times, date of the complaint start, number of SNS application, type of fistula and frequency of fistula discharge were recorded. RESULTS: A total of 49 patients were included in this study. Forty-four (% 89.8) of them were male. The mean age was 44.9. Twenty-eight patients (57.1%) had intersphincteric fistulas, while twenty-two patients (42.9%) had intersfinteric fistulas. Mean number of SNS application was 4.1 (1-6). Patients in Group 1 had mean number of SNS therapy as 3.42 (1-6), whereas cases in Group 2 this number was 5.5 (3-6). Patients were observed approximately for 8.84 months (6-12). We were able to reach sufficient healing in 13 (%26) cases via 2 times and 20 (%40) cases via 3-6 times application of SNS. CONCLUSION: We were able to reach complete healing rates as % 67 with SNS application in perianal fistula. This is a non-invasive procedure and could be applied in out patient clinics, with low costs. Less complication rates enhances attraction. Patients will not loose chance of surgical treatment. Therefore, we believe SNS may be used as first line treatment in perianal fistulas. KEY WORDS: Follow-up, Perianal fistula, Silver nitrate.

Are the single-step resection and primary anastomosis suitable for obstructive colorectal patients in older cases?

Aim To investigate the efficacy and safety of the single-step surgery in elderly patients with obstructive colorectal cancer. Methods All patients who underwent single-step surgery and primary anastomosis for obstructive colorectal cancer in the period between January 2021 December 2017 were evaluated in this study. The patients were divided into two groups: younger than 65 (Group Young) and older than 65 (Group Old). Demographic data, American Society of Anesthesiologists scores (ASA) scores, comorbidities, preoperative albumin levels, type of surgery, postoperative morbidity and mortality, pathological stages, and overall survival rates were investigated. Results A total of 89 patients were included: 49 (54%) were older than 65 (Group Old). In Group Old, the mean age was 75 (65-97), of which 28 (58.3%) were males. There were 41 patients younger than 65 (Group Young) with the mean age of 52.6 (41-64 years of age), of which 21 (51.2%) were males. There was no difference between groups according to albumin level. There was no statistical difference between two groups according to tumour localization, pathological stage and type of surgery, as well as according to surgical complications. The median overall survival rate was 11 months in both groups (0-66) (p=0.320). Conclusion Meticulous preparation of older patients (correction of anaemia, electrolyte levels and pH ) paves the road for successful surgeries, including single-step resection and primary anastomosis.

Clinical evaluation of negative-pressure wound therapy in the management of electrical burns.

BACKGROUND: In this study, we aimed to evaluate the clinical efficacy and safety of negative-pressure wound therapy (NPWT) in the treatment of the patients with electrical burns. METHODS: This study was retrospectively performed using a database placed prospectively in the burn center of our hospital. All consecutive patients with electrical burns treated using NPWT at our center between August 2008 and December 2012 were included. The treatment results in our study were grouped as successful or unsuccessful considering the treatment objectives in accordance with therapy indications. RESULTS: In total, 39 patients were included in our study; of them, 36 (92.3%) were men. The average age was 34.9±9.8 years (range, 17-63 years). The majority of the patients in our study (92.3%) had been exposed to high voltage electricity. The mean total burned body surface area (TBSA) was 19.3±9.8 (range, 4-44). Six patients (15.4%) had TBSAs ≥30%, 31 (79.5%) had third degree burns, and 8 (20.5%) had fourth degree burns. In our study, indications of NPWT included bone and/or tendon exposed deep wounds that are not suitable for early grafting or flap applications owing to the lack of supporting tissue in 27 (69.2%) patients, graft fixation in 8 (20.5%) patients, and secondary grafting following graft loss in 4 (10.3%) patients. The general success rate of NPWT was 90.7% according to indications and treatment objectives in our study. CONCLUSION: In the light of our results, NPWT may contribute to the present conventional treatments used in severe electrical burns.

Evaluation of the patients with colorectal cancer undergoing emergent curative surgery.

BACKGROUND: The aim of our study is to evaluate perioperative and mid-term oncologic outcomes of the patients with colorectal cancer, who underwent emergent curative surgery. METHODS: The study included all patients with colorectal cancer, who underwent surgery for curative intent between 1 January 2012 and 31 December 2014 in General Surgery Department of Kartal Training and Research Hospital. The patients were divided into two groups according to the type of admission (emergent or elective). The data of the patients were retrospectively collected with chart review. Demographic characteristics of the patients, ASA scores, emergent indications and surgical interventions, postoperative complications, pathological findings, oncological therapy, and follow-up findings were investigated. RESULTS: Fifty-one and 209 patients were evaluated in both groups, respectively. Rate of right sided and sigmoid/recto-sigmoid tumors were significantly higher in emergent group. Ostomy rate, early morbidity, ICU need, transfusion, and mortality rates in emergent group were significantly higher than elective group. Average length of hospital stay in emergent group was also significantly longer in elective group (11.2 ± 3.2 vs. 8.4 ± 2.4 days). The patients in emergent group had a much lower survival rate than those in elective group. CONCLUSION: In our study, emergency presentation of colorectal cancer was found associated with increased morbidity, a longer length of stay, increased in-hospital mortality, advanced pathologic stage and worsened long term survival in even same stages.

The effect of fibrin glue on the intensity of colonic anastomosis in the presence and absence of peritonitis: an experimental randomized controlled trial on rats.

Aim. Anastomotic leakage after colon anastomosis is the most frequent and most feared complication with its highest mortality rate. In this study, we aimed to expose the impact of performing fibrin glue on sutured colocolic anastomosis, in the presence of experimental peritonitis, on anastomosis safety. Method. In this experimental study, the rats were divided into two groups as control group (Groups 1 and 3) and experimental group (Groups 2 and 4). They were also divided as clean abdomen (Groups 1 and 2) and infected abdomen (3 and 4) groups. Full-thickness incisions were made on the proximal colon of both groups of rats. The control group's anastomoses were conducted only with sutures, whereas in experimental group, fibrin glue was applied over the sutures. The samples were taken on the 10th day. Results. Highest values for average levels of hydroxyproline in the tissues and anastomotic bursting pressures were detected when fibrin glue was applied on sutured anastomosis in clean abdomen. In the histopathological staging performed in line with Ehrlich-Hunt model, lowest values were detected during the presence of peritonitis. Conclusion. As a result, it has been established that the use of fibrin glue over sutured colocolic anastomosis, both in clean abdomen and in the presence of peritonitis, had increased anastomosis safety.

Active gas aspiration to reduce pain after laparoscopic cholecystectomy.

OBJECTIVE: To investigate to what effect active subdiaphragmatic gas aspiration reduces pain after a laparoscopic cholecystectomy. MATERIALS AND METHODS: A total of 104 patients undergoing laparoscopic cholecystectomy were randomly placed into 2 groups. Group I included active subdiaphragmatic gas aspiration (n=52) while group II included simple evacuation (n=52) without any additional procedures. Postoperative analgesic requirements were recorded and the level of postoperative abdominal and shoulder pain was assessed using a numeric scale after 24 postoperative hours. Data were analyzed using the χ test for nonparametric data and Student t test for parametric data. RESULTS: Age, volume of CO2 used during surgery, and operation duration were similar in the 2 groups. The simple evacuation group (group II) experienced more shoulder and abdominal pain postoperatively when compared with the active subdiaphragmatic aspiration group (group I) and had a higher use of analgesics during the postoperative period. CONCLUSIONS: Active subdiaphragmatic gas aspiration after a laparoscopic cholecystectomy is a simple procedure that can effectively reduce postoperative abdominal and shoulder pain and as a result the need for analgesics.

The association of serum adiponectin levels with histopathological variables in gastric cancer patients.

Adiponectin is a peptide hormone secreted from the adipose tissue, affecting the proliferation and insulin sensitivity in different cell types. The levels of adiponectin have been found to be decreased in hyperinsulinemia and insulin resistant states, such as obesity. The previous studies have suggested that plasma adiponectin levels are decreased in patients with endometrial and breast cancer. In our study, the relationship among serum adiponectin levels, demographic features and histopathological variables was evaluated in gastric cancer patients. Forty consecutive patients with gastric cancer who underwent gastrectomy with standard lymph node dissection were included and 43 healthy controls were included in this study. The serum levels of glucose, insulin, C-peptide, HbA1c and adiponectin were measured in both groups. We analyzed the correlation among these parameters and patients' demographic features, such as age, gender, body mass index (BMI) and histopathological variables such as tumor localization, stage, nodal status, histological grade, vascular and lymphatic invasion. The mean age was 60.05+9.72 in patients, while it was 38.6+12.73 in controls. The mean serum adiponectin levels were 12.62+7.9 and 10.07+6.72 ng/ml, respectively, in groups. There was no different in terms of adiponectin, C-peptide, HOMA-R level in both groups. On the other hand, BMI, glucose and insulin levels were significantly different in gastric cancer patients in comparison with the controls. There was no correlation among the levels of adiponectin, BMI, insulin and c-peptide levels in patient group (P>0.05). The adiponectin levels of woman were significantly lower than male patients (P=0.002). No relations were detected among tumor stage, tumor localization, nodal status, lymphatic and vascular invasion, and the levels of serum adiponectin (P>0.05). Interestingly, a positive correlation was found between tumor grade and plasma adiponectin levels (r=0.372; P=0.018). Our results suggest that plasma adiponectin levels were similar in both patients with gastric cancer and the controls. In addition, no correlation was found between adiponectin levels and demographic features and histopathological variables of patients. But, in undifferentiated tumors, plasma adiponectin level was significantly higher than well-differentiated grade tumors.

Efficacy of preoperative albendazole use according to months in hydatid cyst of the liver.

PURPOSE: Hydatid cyst is still a significant health and economical problem due to insufficient preventive measures. Infestation by hydatid disease in humans most commonly occurs in the liver and causes complications unless treated properly. Therefore, hepatic hydatid cyst should immediately be treated when diagnosed. Today, the treatment of hydatid cysts is principally surgical. To avoid recurrence, viable scoleces in the hydatid cyst should be eliminated before emptying surgically. Length of Albendazole therapy, a drug effective on scoleces in the cyst, is still controversial. METHODS: In this study, there was a significant difference in the rate of viable scoleces when group III receiving albendazole for 3 months preoperatively was compared with group I, group II, and the control group. We do think 3-month preoperative abendazole treatment is effective in reducing the rate of recurrence and if still viable scoleces are observed in the surgery, albendazole treatment should be continued for 1 month postoperatively. RESULTS: After the therapy, in group I 10 (47.6%), in group II 7 (33.3%), and in group III 2 (0.9%) patient's scoleces were alive. In the control group (group IV) 17 (80%) patients' scoleces were intact. When group III is compared with the control group, a significant difference was observed (P<0.05). Yet again, there was a significant difference between the groups when groups I and II were compared with group III. CONCLUSIONS: We concluded that in treatment of hydatid cyst, albendazole should be continued at least for 3 months preoperatively and if still viable scoleces are identified, medical treatment should follow the surgical intervention at least for 1 month to decrease the possibility of residual cysts and recurrence.

Effect of peritoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis.

PURPOSE: The reported antibacterial, antiendotoxic, and antiadhesive effects of taurolidine prompted us to study the benefits of intraperitoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis. METHODS: We induced peritonitis in 40 rats by injecting Escherichia coli isolate intraperitoneally. We performed colonic resection and primary anastomosis 5 h later, after lavage with either taurolidine or saline solution. After the rats were killed, on postoperative day (POD) 3 (n = 10) or 7 (n = 10), we measured the bursting pressures and hydroxyproline levels, then examined the resected specimens histologically. RESULTS: Bursting pressures and tissue hydroxyproline levels were significantly higher in the taurolidine group than in the control group on PODs 3 and 7 (P < 0.05). Histopathological examination revealed significantly higher fibroblastic activity in the taurolidine group. CONCLUSIONS: The higher bursting pressures and tissue hydroxyproline levels in the rats given taurolidine showed the positive effect of taurolidine on anastomotic strength in secondary peritonitis. Taurolidine is a novel antibiotic with both antibacterial and antiendotoxic effects. Intraperitoneal lavage with taurolidine solution may reduce the risks associated with performing primary colonic anastomosis in patients with secondary peritonitis.

[The effects of abdominal compartment syndrome on the serum urea and creatinine levels]. / Abdominal kompartman sendromunun serum üre ve kreatinin üzerine etkisi.

BACKGROUND: The purpose of this study was to assess the effects of abdominal compartment syndrome (ACS) on the kidneys. METHODS: Intra abdominal pressures (IAP) were indirectly measured through urinary bladder. The patients were categorised into four groups according to IAP levels. Serum urea and creatinine levels and IAP were measured once a day. Abdominal decompression was planned according to IAP as well as clinical assessment. RESULTS: The number of patients in this study was 25. Serum urea and creatinine levels were highest in the group IV (group in which abdominal pressure was above 31 cmH2O) (t > 0.05). Five of the 25 patients were died and anuria developed in these five patients before death. In three of five patients abdominal decompression operations were performed. CONCLUSION: ACS is an unusual and often lethal syndrome. The most important treatment is abdominal decompression and we conclude that it should be done in patients with IAP 30 cmH2O or above to protect renal function.