Asymmetric transmission in prisms using structures and materials with isotropic-type dispersion.

It is demonstrated that strong asymmetry in transmission can be obtained at the Gaussian beam illumination for a single prism based on a photonic crystal (PhC) with isotropic-type dispersion, as well as for its analog made of a homogeneous material. Asymmetric transmission can be realized with the aid of refraction at a proper orientation of the interfaces and wedges of the prism, whereas neither contribution of higher diffraction orders nor anisotropic-type dispersion is required. Furthermore, incidence toward a prism wedge can be used for one of two opposite directions in order to obtain asymmetry. Thus, asymmetric transmission is a general property of the prism configurations, which can be obtained by using simple geometries and quite conventional materials. The obtained results show that strong asymmetry can be achieved in PhC prisms with (nearly) circular shape of equifrequency dispersion contours, in both cases associated with the index of refraction 01. For the comparison purposes, results are also presented for solid uniform non-magnetic prisms made of a material with the same value of n. It is shown in zero-loss approximation that the PhC prism and the ultralow-index material prism (01. Possible contributions of scattering on the individual rods and diffraction on the wedge to the resulting mechanism are discussed. Analogs of unidirectional splitting and unidirectional deflection regimes, which are known from the studies of PhC gratings, are obtained in PhC prisms and solid uniform prisms, i.e. without higher diffraction orders.

Prevalence of IgE mediated cow's milk and egg allergy in children under 2 years of age in Sanliurfa, Turkey: the city that isn't almost allergic to cow's milk.

AIM: Food allergy is a common problem in children and adults. The aim of this study was to determine the frequency of cow's milk and egg allergy based on skin prick test and oral food challenge results METHODS: We recruited 614 children aged 1 month-2 years in from different areas of Sanliurfa. An interview was conducted with each parents and family demographic, and prenatal-antenatal-postnatal information was recorded, then skin prick test was applied to the children for egg white, egg yolk and cow's milk. Cases that are required, sIgE levels for cow's milk, egg white and egg yolk were measured and food challenge tests were applied. RESULTS: Cow's milk and egg allergy was determined in 1 case (0.16%) and 8 cases (1.30%) respectively from the results of the tests applied. Six cases (0.97%) were accepted as sensitive to egg white and egg yolk. Within the factors which were questioned, (only the egg allergy evaluation was made without the cow's milk allergy case) of those with parental consanguinity was determined at a statistically significantly high level (OR=5.8, 95% CI: 1.2-27.2, P=0.01). CONCLUSION: The prevalence of cow's milk allergy in Sanliurfa is the lowest reported prevalence rate to date in children under 2 years of age. When infants develop a food allergy, this takes the form of egg allergy. Within the several factors evaluated to explain this situation, a significant relationship was determined only with parental consanguinity. However, as reported above, to date there is no genetic or epidemiological study to explain this situation.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements.

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Multiple slow waves and relevant transverse transmission and confinement in chirped photonic crystals.

The dispersion properties of rod-type chirped photonic crystals (PhCs) and non-channeled transmission in the direction of the variation of structural parameters from one cell of such a PhC to another are studied. Two types of configurations that enable multiple slow waves but differ in the utilized chirping scheme are compared. It is demonstrated that the multiple, nearly flat bands with a group index of refraction exceeding 180 can be obtained. For these bands, transmission is characterized by multiple narrow peaks of perfect transmission, strong field enhancement inside the slab, and large values of the Q-factor. Among the bands, there are some that show negative phase velocity. Symmetry with respect to the slab mid-plane must be kept in order to obtain constructive interferences that are necessary for reflection-free transmission. It is shown that 15 and more slow wave bands can be obtained in one configuration. The corresponding transmission peaks are well separated from each other, being the only significant feature of the transmission spectrum, while the Q-factor can exceed 105. The observed features are preserved in a wide range of the incidence angle variation. They can be used for tuning the locations and spectral widths of the transmission peaks. Some comparisons with the chirped multilayer structures have been carried out.

Pancreas transplantation: experience of single center.

BACKGROUND: Diabetes is the most common cause of renal failure. In patients with type I diabetes and renal failure,dialysis and insulin therapy can prevent a clinical context that causes rapid death, but they are insufficient to prevent longterm complications. Pancreas and islet cell transplantation inpatients with type I diabetes are the only curative treatment and have recently become more common. METHODS: Between December 2006 and August 2010 a total of 10 patients underwent pancreas transplantation. The patient's data were analysed retrospectively. RESULTS: 10 patients and their data were included in this study. Six patients were male and 4 patients were female. All patients are still alive, with functional grafts. CONCLUSIONS: Pancreas transplantation is the most effective treatment for patients with type I DM. This paper discusses the feasibility of this process and presents the experience of Ankara University in pancreas transplantation.

Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions.

BACKGROUND/PURPOSE: Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model. METHODS: Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems. RESULTS: All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used. CONCLUSIONS: Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

Single-port laparoscopic surgery by use of a surgical glove port: initial experience with 25 cases.

BACKGROUND: single-port laparoscopic surgery has gained popularity over the last decade. This technique is used for several surgical procedures. This paper documents a new and cheaper access method known as "surgical glove port" or "homemade single-port", and describes our initial experience with 25 cases. METHOD: Eleven cholecystectomies, eight totally extraperitoneal inguinal hernia repairs, three splenectomies, two gastric wedge resections, and one anti-reflux procedure were performed. RESULTS: Twenty-four procedures out of twenty-five were completed without conversion to open or multiple port techniques. An individual patient who had both cholelithiasis and gastrointestinal stromal tumor underwent both cholecystectomy and gastric wedge resection in the same session with surgical glove port technique. In another case two additional 5-mm incisions were made for hemostasis. The additional operation was required and performed by using surgical glove port for a hiatal hernia repair case, because of postoperative hemorrhage. CONCLUSION: Single-port laparoscopic surgery is an applicable technique for plenty of surgical procedures. Also, surgical glove port is a newer technique and some initial experience shave already published all over the world. Surgical glove port has advantages such as cost-effectiveness, easy and safe port implantation and specimen extraction. SGP can also be used for treating post-operative complications.

Multichannel optical diode with unidirectional diffraction relevant total transmission.

We will show that broadband unidirectional optical transmission with a total transmission maximum inside the band can be obtained for linearly polarized incident waves in the nonsymmetric photonic crystal gratings made of isotropic linear materials at a fixed nonzero or zero angle of incidence. Being based on the merging of diffraction and dispersion effects, the basic physical mechanism studied exploits the transmission channels associated with higher orders, for which asymmetry in the coupling conditions at the two grating interfaces appears when spatial inversion symmetry is broken. Total transmission in one direction and zero transmission in the opposite direction can be obtained due to hybridization of Fabry-Perot type resonances with a diffraction anomaly that yields a diode-like operation regime. Single-beam deflection and two-beam splitting can be obtained, for which transmission can be (nearly) total, if the corrugated side is illuminated. In contrast to the previous studies, it is also shown that unidirectional transmission can appear only at a fixed frequency and only due to diffractions, when total transmission occurs at the noncorrugated-side illumination, being in agreement with the Lorentz Lemma.

Dispersion irrelevant wideband asymmetric transmission in dielectric photonic crystal gratings.

Wideband suppression of zero order and relevant strongly asymmetric transmission can be obtained in photonic crystal gratings that are made of linear isotropic materials and show the broken structural (axial) symmetry, even if zero diffraction order may be coupled to a Floquet-Bloch (FB) wave at the incidence and exit interfaces. The studied mechanism requires that the peculiar diffractions at the corrugated exit interface inspire strong energy transfer to higher orders, including those not coupled to an FB wave. At the opposite direction of incidence, transmission due to zero and some higher orders that may be coupled at the corrugated input interface can vanish. This leads to the alternative scenario of wideband unidirectional transmission, which itself does not need but can coexist with the other scenario based on the merging of asymmetric diffraction and dispersion of the FB mode.

Pancreatic cancer complicated by splenic infarction and abscess.

Pancreatic tail adenocarcinoma is both a diagnostic and therapeutic challenge. Despite technical and therapeutic advances, the prognosis remains dismal; the average survival time after diagnosis is characteristically only five to eight months. Both splenic infarction and abscess are very rare complications of pancreatic cancer. In this case of splenic infarction, the possible source of emboli should be carefully investigated. In addition, splenic abscess must be suspected in patients with splenic infarction, especially if the infectious signs persist despite appropriate treatment. Rapid diagnosis and treatment are essential as its course can prove fatal. The patient presented herein had a splenic infarct and abscess as complications of pancreatic tail carcinoma. The treatment of choice was splenectomy and distal pancreatectomy with resection of involved organs. The variability in clinical presentation and imaging studies warrants consideration of this entity in the differential diagnosis of many splenic and pancreatic lesions.

Effects of N-butyl-2-cyanoacrylate on high-level jejunojejunostomy.

BACKGROUND: Morbidity and mortality due to anastomotic complications in gastrointestinal surgery remain important problems. The tissue adhesive N-butyl-2-cyanoacrylate (NB2CA) is used in many fields of surgery. This study was designed to assess the effects of NB2CA on high-level jejunojejunostomy. MATERIALS AND METHODS: Forty male albino Wistar rats were divided into 4 groups of 10 each. The groups were treated as follows: group 1 underwent only a jejunojejunostomy, group 2 underwent jejunojejunostomy followed by NB2CA application around the anastomosis, group 3 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion, and group 4 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion followed by NB2CA application around the anastomosis. At postoperative day 7, the subjects in all groups were sacrificed. Intra-abdominal adhesions, anastomotic complications and anastomotic burst pressures (ABP) were recorded. RESULTS: The analysis of all the groups for adhesion scores and ABP showed statistical significance (p < 0.001). CONCLUSIONS: The use of NB2CA had positive effects in terms of increasing ABP both with and without the initial ischemia- reperfusion insult. However, it had the adverse effect of significantly increasing the number of intra-abdominal adhesions.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst.

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Identification of post-transplant lymphocele using lymphatic mapping with isosulphane blue.

Lymphocele development after renal transplantation is a well-recognized complication that occurs with the incidence of 0.6-18%. Although the majority of patients are asymptomatic, post-renal transplant lymphocele continues to be a major cause of morbidity if it is left untreated. The standard approach for the treatment of symptomatic lymphoceles is accepted to be laparoscopic or open marsupialization in many centers if simple drainage and conservative measures fail. However, marsupialization is almost impossible under certain circumstances, such as in the case of excessive abdominal adhesions. Hence, direct visualization of the lymphatic leak and suture ligation may become inevitable, which is usually a challenging procedure for the surgeon. Herein we report a case of post-renal transplant lymphocele treated by the direct identification and suture ligation of injured lymphatic vessel using a new method similar to sentinel lymph node detection using the dye isosulphane blue.

Occlusion of the celiac trunk, the inferior mesenteric artery and stenosis of the superior mesenteric artery in peripheral thrombangiitis obliterans.

Buerger's disease is an inflammatory occlusive disease which commonly involves medium-sized or smaller vessels of extremities. Mesenteric involvement in Buerger's disease is very rare. It can occur at any time during the course of the disease and presents with acute mesenteric ischaemia. In this study, a case of Buerger's disease with mesenteric involvement diagnosed before the onset of acute mesenteric ischaemia and managed endovascularly is reported.

Partial cholecystectomy is a safe and efficient method.

AIM: When there is excess inflammation, fibrosis and portal hypertension around gall bladder or in presence of Mirizzi syndrome, bile ducts and hepatic artery may be possibly damaged during dissection of Calot triangle. In this study, we examined safety and efficiency of partial cholecystectomy operation which we perform when dissection of Calot triangle is challenging. METHOD AND MATERIAL: Eighteen patients who were undergone partial cholecystectomy in our clinic between 1996 and 2008 were retrospectively evaluated. Mean age of patients was 66 years (range: 55-88 years) and ratio of male/female was 2/1 (12 men, 6 women). Fourteen patients were undergone general anesthesia, whereas 4 patients were operated under epidural anesthesia. Partial cholecystectomies were performed by right subcostal incision in 16 patients and by right paramedian incision in 2 patients. RESULTS: No intra-operative or early post-operative mortality was found among patients. Post-operative subhepatic abscess occurred in one patient (5.5%) and superficial wound site infection occurred in 4 patients (22,2%). Controlled bile fistula occurred in early post-operative period in two patients (11.1%) and fistula spontaneously closed without requiring additional surgical procedure. Escherichia coli were most common microorganism found in bile culture. Mean hospitalization period of patients was 8 days (range: 15-14 days) and mean follow-up period was 80 months (8-150 months). During follow up, hepatobiliary ultrasonography could be re-performed in 8 patients and no new stone formation was observed. In 7 patients, it was understood verbally that no postoperative gastrointestinal symptoms were present. CONCLUSION: Where dissection of Calot triangle is changeling, partial cholecystectomy can be safely and efficiently performed.

Statin therapy and diabetic skin.

PURPOSE: Statins are widely used drugs for reducing cholesterol levels. The aim of this study was to observe the effects of statin therapy on skin histopathology in both normal and diabetic mice. METHODS: 45 Swiss albino mice were studied in 4 sub-groups: control, statin-treated control, diabetic, and statin-treated diabetic. The first group was diabetic-induced with 250 mg/kg of streptozosin administered intravenously. The second group served as the control. Four weeks after streptozosin injection, both diabetic and control groups were divided into 2 sub-groups and 1 mg/kg/d simvastatin was injected for 14 d intraperitoneally to form the statin-treated control and statin-treated diabetic groups. The remaining 2 groups formed the untreated control and untreated diabetic groups. Histopathological examination of the skin was made with haematoxylin eosin staining under a light microscope. RESULTS: There was no apparent difference between the groups in epidermal thickness, proliferative activity, dermal thickness and composition. Cystic dilatations in the infundibulum of hair follicles with distorted and smaller sebaceous glands were seen in the statin-treated control, diabetic, and statin-treated diabetic groups. CONCLUSION: We conclude that there is altered lipid synthesis in the sebaceous glands in both diabetic and statin-treated groups.

VACTERL-H associated with central hypothyroidism: a case report.

The VACTERL-H syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTERL-H has previously not been reported.

Incisional hernia treatment with polypropylene graft: results of 10 years.

PURPOSE: To report herein our results of tension-free repair of large incisional hernia with polypropylene mesh using a modification of the method that was described by Usher. METHOD: Two hundred ninety-one patients who were operated on between January 1994 and December 2004 were studied. Two hundred thirty-two patients were female (79.7%), and 59 were male (20.3%). The average follow-up period was 55 months. The patients were evaluated for infection, recurrences, hematoma and seroma formation, sinuses and enterocutaneous fistula formation. RESULTS: Infection was observed in eight patients (2.7%). Graft removal due to infection was encountered only in two patients (0.6%). Recurrence was observed in six patients (2.1%). Two patients (0.6%) developed hematoma while another two developed seroma. No patient developed enterocutaneous fistula. CONCLUSION: By using our modified technique we can decrease the expected complications after tension-free repair of large incisional hernias.

A review on the role of laparoscopy in pancreatic cancer.

BACKGROUD: Pancreatic cancer is the fourth leading cause of cancer death in the United States and leads to an estimated 227,000 deaths per year worldwide. Palliative and curative treatments are used for pancreatic cancer by laparoscopic or open techniques. The role of laparoscopy in pancreatic cancer is evaluated in this study. MATERIAL AND METHODS: Electronic databases, such as PubMed/MEDLINE and Google Scholar were searched to identify reports of trials for laparoscopic pancreatic surgery. Articles written in English including the maximum number of patients published -between 2010 and 2014 were included. RESULTS: Recent reports on laparoscopic surgery of the pancreas are encouraging and support the advantages of laparoscopy. Although large series have been reported for benign pancreatic -tumors treated with laparoscopic procedures, only limited data are available for malignant lesions. Most of these studies are retrospective, but the results encourage laparoscopic procedures. CONCLUSION: Over the last decade laparoscopic pancreatic surgery has emerged as an alternative to open surgery with many advantages. There are limited data on about laparoscopic approach for the treatment of malignant lesions. The results are in favor of laparoscopy.

An investigation of the factors that affect surgical hand disinfection with polyvidone iodine.

This study investigated the factors influencing the effectiveness of 7.5% polyvidone iodine as a surgical antiseptic. The study involved 100 operating staff (75 doctors and 25 nurses) from hospital surgical teams. Fingertips of both hands of the subjects were pressed on to agar culture before and after washing and after completion of surgery. Handwashing lasting for more than 3 min led to a significant decrease in the number of colonies compared with handwashing lasting for less than 3 min. Moreover, the number of colonies was significantly higher when surgery lasted for longer than 95 min. However, the handwashing style (with or without brushing) was not found to have a significant effect on the outcome of the disinfection procedure in terms of bacterial colonization. Subjects who had colonization of their hands after surgery were found to have significantly higher colony counts before handwashing compared with those who did not have any colonization on their hands after surgery. The results of this study revealed that in order to attain effective disinfection with polyvidone iodine, the duration of handwashing should be at least 3 min. The risk of recolonization increases when the duration of surgery exceeds 95 min.