Etiopathogenetic factors, thyroid functions and thyroid autoimmunity in melasma patients.

INTRODUCTION: Melasma is a common chronic, acquired pigmentation disorder with a significant impact on the quality of life of patients. AIM: To investigate the etiopathogenetic factors, thyroid functions and thyroid autoimmunity in patients with melasma. MATERIAL AND METHODS: Forty-five women with melasma and 45 age-matched healthy women were included in the study group. A detailed history was taken from the patients including triggering factors of melasma. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin (AbTG) and anti-thyroid peroxidase (Ab-TPO) were measured and thyroid ultrasonography was performed for each subject. RESULTS: In 26.7% of patients, pregnancy, in 17.8%, oral contraceptive use and in 13.3%, intense sunlight exposure were the triggering factors. 17.8% of patients had a family history of melasma. FT4, TSH and AbTG levels were significantly higher in the patient group. CONCLUSIONS: The results suggest that a combination of factors including pregnancy, oral contraceptive use, sunlight and genetic factors often trigger melasma. Thyroid hormones and thyroid autoimmunity may also play a role in the pathogenesis which needs to be proven by further studies.

Permanent stoma not only affects patients' quality of life but also that of their spouses.

BACKGROUND: Living with a permanent colostomy can significantly diminish a patient's quality of life. However, little is known about the effects on the patient's spouse. Therefore, the aim of the present study was to evaluate the quality of life of spouses whose partners had undergone sphincter-sacrificing surgery for rectal carcinoma. METHODS: We studied 56 couples after one partner underwent sphincter-sacrificing surgery for rectal carcinoma: female spouses (n = 30) and male spouses (n = 26). To identify how surgery affected the life standards of the spousal population, questionnaires were constructed by the Department of Public Health, General Surgery and Psychology at the University of Ankara. RESULTS: Sixteen of 26 male spouses increased time spent at home, whereas 10 of 30 female spouses increased time spent at home (p < 0.05, male spouses versus female spouses). All of the spouses had been sexually active before their partners' operation; however 20 of 26 male spouses and 10 of 30 female spouses were sexually inactive afterward (p < 0.05, male spouses versus female spouses). Ten male patients and 3 female patients wanted their colostomy care to be managed by their spouses (p < 0.01, female spouses versus male spouses). CONCLUSIONS: In a patient with a colostomy, the social and sexual aspects of the life of the patient's spouse are affected. This observation needs to be taken into account when patients are preoperatively counseled. Therefore, preoperative counseling regarding the possible problems after surgery should not only include the patient but also the spouse.

Suprarenal symplastic leiomyoma of the inferior vena cava.

We report on a case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. En bloc excision of the tumor with the right adrenal gland and the involved segment of the vena cava was carried out. Histopathological work-up of the tumor revealed smooth muscle fibers and marked nuclear pleomorphism consistent with symplastic leiomyoma. This case report presents a distinct histological variant of the rarely seen primary smooth muscle tumor of the inferior vena cava.

Fournier's gangrene: is it scrotal gangrene?

INTRODUCTION: Fournier's gangrene was originally described as scrotal gangrene in young males. Today, it is generally accepted as synergistic necrotizing fasciitis of perineal, genital, or perianal regions, and the epidemiologic data have changed. However, there are still limited data about females due to the lack of female patients, even in large case series. METHODS: A retrospective review of the medical records of all patients who received surgery for emergency conditions over the past 22 years was performed to identify patients with Fournier's gangrene. Data from these patients were then reviewed to determine the age, gender, etiology, causative bacteria, predisposing factors, treatment modalities, length of hospital stay, and morbidity and mortality rates associated with Fournier's gangrene. Data were evaluated using multivariate analyses. RESULTS: Sixty-five patients (20 female) were identified with the diagnosis of Fournier's gangrene. The mean age was 50.8 years. The most common etiology was hemorrhoidectomy in male and perianal abscess in female patients. The most commonly isolated microorganism in both male and female patients was Escherichia coli. Twenty-nine patients had diabetes mellitus, which was the most common predisposing factor. Mean hospitalization time was 24.4 days and the overall mortality was 27.70%. CONCLUSION: Fournier's gangrene is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. It seems that there are no major differences between male and female patients in the characteristics of the condition.

Trocar site hernia after laparoscopic cholecystectomy.

AIM: The aim of this study was to elucidate the influence of pre and perioperative factors on the development of trocar site hernia after a laparoscopic cholecystectomy procedure. PATIENTS AND METHODS: A total of 776 patients who underwent a laparoscopic cholecystectomy procedure in our Department of General Surgery between 1999 and 2004 were assigned as the study group. The control group included patients without trocar site hernias after a cholecystectomy. The effect of five variables, including gender, age, body mass index (BMI), operation duration, and the type of cholecystitis on the development of a trocar site hernia after a laparoscopic cholecystectomy was assessed by univariable and multivariable models. RESULTS: In the univariate analysis, female gender (P = 0.021), older age (P < 0.001), higher BMI at the time of surgery (P < 0.001), and an increased duration of surgery (P < 0.001) have been found to increase the likelihood of a trocar site hernia formation. However, in the multivariable model, the gender was not a significant variable to influence the development of this complication. CONCLUSIONS: The development of a postoperative trocar site hernia may be prevented by the closure of 10-mm trocar sites in patients who are older than 60 years, obese, and who have a longer duration of operation.

Splenic hamartoma is a rare cause of abdominal pain: Case report and literature review.

Hamartoma is a rare benign tumor of the spleen. It is often asymptomatic and diagnosed incidentally. In this study, we report the case of a 51-year-old female patient who was admitted to our department for intermittent epigastric pain since the last 6 months and left upper quadrant fullness. She was diagnosed with splenic hamartoma histopathologically after splenectomy. Although splenic hamartoma is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions.

[A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair]. / Comparação de duas doses diferentes de morfina adicionadas à bupivacaína em raquianestesia para herniorrafia inguinal.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1mg (Group I, n=22) or 0.4mg (Group II, n=26) ITM in addition to 7.5mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p<0.05 was considered as statistically significant. The numeric data were analyzed by the t-test and presented as mean±SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n=6) of the patients had vomiting during the first postoperative 24h compared to 0% in Group I (p=0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1mg of ITM provides comparable postoperative analgesia with a dose of 0.4mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.

A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1mg (Group I, n=22) or 0.4mg (Group II, n=26) ITM in addition to 7.5mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p<0.05 was considered as statistically significant. The numeric data were analyzed by the t-test and presented as mean±SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n=6) of the patients had vomiting during the first postoperative 24h compared to 0% in Group I (p=0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1mg of ITM provides comparable postoperative analgesia with a dose of 0.4mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.

Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%. As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world. Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic), the ideal anesthesia (general, local, or regional), and the ideal mesh (standard polypropylene or newer meshes).

Surgical glove-port single-incision laparoscopic gastric wedge resection of gastrointestinal stromal tumors: initial experience with 2 cases.

Gastrointestinal stromal tumors are localized mainly in the stomach, and the therapeutic approach is surgical resection. Laparoscopy can be performed for tumors located in the greater curvature of the stomach. Among the treatment alternatives, a single-incision laparoscopic technique is used more frequently than standard laparoscopy due to the successful results of laparoscopic surgery. Here, we report the use of single-incision surgical glove-port laparoscopy for the resection of 2 gastrointestinal stromal tumors localized in the greater curvature of stomach.

Outcome of the patients with chronic mesh infection following open inguinal hernia repair.

PURPOSE: Hernia repairs are the most common elective abdominal wall procedures performed by general surgeons. The use of a mesh has become the standard for hernia repair surgery. Herein, we discuss a management strategy for chronic mesh infections following open inguinal hernia repair with onlay prosthetic mesh. METHODS: In this study, 15 patients with chronic mesh infections following open inguinal hernia repairs were included. The medical records of these patients were retrospectively reviewed and information regarding presentation, type of previous hernia repair, type of mesh, operative findings and bacteriological examination results were obtained. In all cases, the infected mesh was removed completely and the patients were treated with antibiotic regimens and local wound care. RESULTS: Fifteen mesh removals due to chronic infection were performed between January 2000 and March 2012. The mean interval of hernia repair to mesh removal was 49 months. All patients were followed up for a median period of 62 months (range, 16 to 115 months). In all patients, the infections were resolved successfully and none were persistent or recurrent. However, one patient developed recurrent hernia and one developed nerve injury. CONCLUSION: Chronic mesh infection following hernia repair mandates removal of the infected mesh, which rarely results in hernia recurrence.

Pentoxifylline use in dermatology.

Pentoxifylline is methylxanthine derivative which is used in microcirculatory disorders as a vasoactive drug. Novel immunomodulatory properties of pentoxifylline have been reported including the down regulation of tumour necrosis factor-α synthesis and other inflammatory cytokines. Studies have shown that pentoxifylline might be efficacious in a wide spectrum of skin diseases. This article focuses on the use of pentoxifylline which is a safe and cheap drug in various dermatological disorders.

A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair / Comparação de duas doses diferentes de morfina adicionadas à bupivacaína em raquianestesia para herniorrafia inguinal

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1 mg (Group I, n = 22) or 0.4 mg (Group II, n = 26) ITM in addition to 7.5 mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p < 0.05 was considered as statistically significant. The numeric data were analyzed by thet-test and presented as mean ± SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n = 6) of the patients had vomiting during the first postoperative 24 h compared to 0% in Group I (p = 0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1 mg of ITM provides comparable postoperative analgesia with a dose of 0.4 mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.

RESUMO JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos de duas doses diferentes de morfina intratecal (MIT) sobre a analgesia no pós-operatório, os tempos até a primeira mobilização e micção no pós-operatório e a gravidade dos efeitos colaterais. MÉTODOS: Após a aprovação do Comitê de Ética Institucional, 48 pacientes com estado físico ASA I-II foram incluídos neste estudo randômico e duplo-cego. A raquianestesia foi feita com 0,1 mg (Grupo I, n = 22) ou 0,4 mg (Grupo II, n = 26) de MIT adicionados a 7,5 mg de bupivacaína hiperbárica. Os tempos até a primeira necessidade de analgésico, mobilização e micção e os efeitos colaterais no pós-operatório foram registrados. As análises estatísticas foram feitas com o programa SPSS 15.0 e p < 0,05 foi considerado estatisticamente significativo. Os dados numéricos foram analisados com o teste t e expressos como média ± DP. Os dados categóricos foram analisados com o teste do qui-quadrado e expressos como número de pacientes e porcentagem. RESULTADOS: Os dados demográficos foram semelhantes entre os grupos. Não houve diferenças em relação à dor, aos tempos até a primeira necessidade de analgésicos, à primeira mobilização e primeira micção. A única diferença entre os dois grupos foi a incidência vômito. No Grupo II, 23% (n = 6) das pacientes apresentaram vômito durante as primeiras 24 horas de pós-operatório, em comparação com 0% no Grupo I (p = 0,025). CONCLUSÃO: Para herniorrafia inguinal, a dose de 0,1 mg de MIT fornece analgesia comparável à dose de 0,4 mg, com uma incidência de vômito significativamente menor quando combinada com uma dose baixa de bupivacaína hiperbárica.

Multiple renal arteries challenge in laparoscopic donor nephrectomy: how far can we go?

PURPOSE: Living donor kidneys with multiple arteries are routinely procured laparoscopically. We aim to present our experience with laparoscopic donor nephrectomy (LDN) and to compare the graft function and outcome between cases with single versus multiple arteries. METHODS: We compared the demographic data, operation time, warm ischemia time, rejection rate, and graft function between LDN kidneys with single artery and those with multiple arteries. RESULTS: Seventy-three cases with 1 renal artery (group LDN-1), 8 cases with 2 renal arteries (group LDN-2) and 5 cases with 3 or more renal arteries (group LDN-3) were included in the study. The mean operative time was significantly higher in groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared to group LDN-1 (75.7 ± 10 minutes, P < 0.001). Similar results were detected with respect to the warm ischemia time. There were no statistically significant differences related to graft function and outcome among these groups. CONCLUSION: Multiple renal arteries present a special challenge in both donor nephrectomy and renal transplantation. However, laparoscopic procurement of a kidney with multiple renal arteries, regardless of the number, is reliable and has no significant impact on the graft outcome.

Colon perforation caused by migration of a bone graft following a posterior lumbosacral interbody fusion operation: case report.

STUDY DESIGN: This is a case report. OBJECTIVE: The purpose was to report a patient whose migrated L4-S1 femur graft led to perforation of the cecum. SUMMARY OF BACKGROUND DATA: Autograft bone use during spinal surgery is quite commonplace nowadays. With time due to infection, technical mishaps, or disease recurrence, these autografts may break off their points of attachments and with their subsequent migration lead to serious complications. METHODS: The patient who had the history of a stabilization operation performed for his L5-S1 spondylolisthesis grade III by way of a L4-L5, S1 transpedicular rod screw presented with high fever and abdominal tenderness. The patient underwent a laparatomy and a perforation on the medial aspect of the cecum, and a femur graft extending into the cecum through the perforation was found. RESULTS: The graft was removed and the cecum was primarily repaired. The patient was discharged on the 15th postoperative day after an uneventful postoperative course. CONCLUSION: We have presented a case whose migrated L4-S1 femur graft led to perforation of the cecum. We recommend that frequent radiologic follow-up should be done in patients at risk to show complications early enough to avert severe consequences.

Why is isolated spleen metastasis a rare entity?

Primary and metastatic tumors of the spleen are uncommon, excluding involvement by lymphoma. Isolated spleen metastasis from other organs is a rare incident. Herein, we report the case of a 59-year-old man who developed isolated splenic metastasis from ascending colon cancer. The patient underwent right hemicolectomy for T3N1M0 tumor of the ascending colon. During the postoperative follow-up, increasing serum level of carcinoembryonic antigen was observed. Furthermore, abdominal computed tomography scan showed a splenic tumor measuring 4 cm. Curative splenectomy was performed. Pathologic investigation confirmed the adenocarcinoma metastasis. The interesting point of our report is that the spleen metastasis arose from the ascending colon. This report is the third described case in the literature of isolated spleen metastasis from a right colon carcinoma.

Upper gastrointestinal abnormalities and Helicobacter pylori in Behçet's disease.

BACKGROUND: There are few published clinical trials concerning upper gastrointestinal (GI) involvement in Behçet's disease (BD), and most have been performed on patients with upper GI tract symptoms. AIM: We sought to determine whether routine endoscopy is indicated in asymptomatic patients with BD and whether Helicobacter pylori plays a role in the pathogenesis of BD. METHODS: Forty consecutive patients with BD and 40 age- and gender-matched controls with tinea pedis were studied. All patients underwent fiberoptic esophagogastroduodenoscopy. Urea breath test was used to identify H. pylori. RESULTS: Abnormalities were noted in 37 patients (93%): hiatal hernia (53%), antral gastritis (33%), pan-gastritis (23%), gastric ulceration (8%), and duodenal ulceration (8%). Helicobacter pylori was found in 26 patients (65%) with BD and in 28 controls (70%) (no significant difference by chi-squared test, P > 0.05). We found a high incidence of upper GI abnormalities in BD, but the abnormalities were not specific for the disorder. CONCLUSIONS: Routine endoscopy and screening for H. pylori infection may not be necessary in asymptomatic patients with BD.

Fatal outcome of disseminated invasive aspergillosis in kidney allograft recipients.

Fungal infections in solid organ transplant recipients are of concern due to the related high mortality and morbidity. Aspergillus species are one of the major opportunistic fungal pathogens causing invasive pulmonary infections which rarely involve extrapulmonary organs. The occurrence varies by type of transplantation, with aspergillosis more frequently associated with heart, liver and lung transplantation cases than those involving kidney recipients. Several risk factors have been proposed, with cases occurring early and late after the transplantation. Although pulmonary involvement is the main presentation, invasive extrapulmonary aspergillosis can on rare occasions be observed and is associated with poor prognosis. Herein, we report two cases that presented with extrapulmonary invasive aspergillosis, i.e., one presented with cerebral abscess and the second with soft tissue abscess in the right posterior thigh. While the cerebral abscess was not surgically treated, the soft tissue abscess was surgically drained. When the primary focus was investigated, pulmonary nodulars were found in both cases. Both patients were treated with long-term amphotericin B; however, one patient was lost with functioning graft and the kidney of the second patient failed due to decreased immunosuppression and he died while on maintenance hemodialysis. Invasive extrapulmonary presentation of aspergillosis rarely occurs in kidney transplant recipients and is associated with a high mortality rate.

Nadroparine blunts lipopolysaccharide-induced hypothermia and behavioral depression in mice.

INTRODUCTION: Despite the use of appropriate antimicrobial therapy and intensive care support, sepsis remains a major cause of morbidity and mortality in surgical clinics. Low-molecular weight heparin treatment may reduce mortality and end-organ failure in sepsis. The purpose of this study was to compare the effects of low-molecular weight heparins such as nadroparine, enoxaparine, and dalteparine on lipopolysaccharide-induced acute phase reaction in mice. METHODS: Lipopolysaccharide was injected intraperitoneally to produce a systemic inflammatory response and septic shock-like effects in adult male BALB/c mice. Mices were treated with low-molecular weight heparins (nadroparine, enoxaparine, dalteparine) and unfractioned heparin in different doses and times. Rectal temperature and spontaneous locomotor activity of the mice were evaluated. RESULTS: Lipopolysaccharide (1 mg/kg, intraperitoneal) produced a hypothermia that occurred 20 minutes after injection. Nadroparine pretreatment (23.75 U/kg, sc) 2 hours before lipopolysaccharide challenge, but not synchronous injection, inhibited the hypothermic response. Pretreatment with equivalent doses of enoxaparine or dalteparine had no effect on the hypothermia. The high dose of lipopolysaccharide (60 mg/kg, intraperitoneal) caused more profound hypothermia and also inhibited spontaneous locomotor activity 24 hours after injection. Synchronous nadroparine administration partially attenuated the hypothermia and significantly abolished the depression of spontaneous locomotor activity. CONCLUSIONS: The results suggest that some low-molecular weight heparins such as nadroparine might be beneficial in high-risk surgical patients because of their potential anti-inflammatory action, in addition to their efficiency in preventing thrombo-embolic complications.