Effect of platelet-rich plasma on postoperative peritoneal inflammation and adhesions.

INTRODUCTION: Postoperative peritoneal adhesion is an important complication of abdominopelvic surgery. The aim of this study is to reveal the effect of platelet-rich plasma (PRP) on postoperative intraperitoneal inflammation and adhesions. MATERIAL AND METHODS: Twenty-four Wistar albino rats were divided into three groups. Cecal incision and suturation was carried out for the experimental model. Intraperitoneally, 3 ml of 0.9% NaCl, 3 ml of PRP, and nothing were applied, and called as saline, PRP, and control groups, respectively. Four subjects in each group were sacrificed at the 3rd and 7th days postoperatively. Adhesion formations and giant cell, lymphocyte/plasmocyte, neutrophil, and histiocyte counts were assessed and hydroxyproline levels were measured in all groups and statistical comparisons were performed. RESULTS: Except giant cell 3rd day scores, PRP had the lowest adhesion, neutrophil, lymphocyte, plasmocyte, histiocyte and fibrosis scores. Both 3rd and 7th days scores of giant cell, neutrophil, lymphocyte, plasmocyte, but only 7th days scores of histiocyte reaction and fibrosis were statistically significant (p < 0.05). Hydroxyproline levels were lower in the saline group at the 3rd day. However, at the 7th day, the levels were lower in the PRP group and no statistically significant difference was found compared to the saline group 3rd day levels (p > 0.05). CONCLUSIONS: Platelet-rich plasma has a reducing effect on the postoperative peritoneal adhesions with separation of the damaged tissues, affecting the inflammation, matrix metalloproteinase, plasminogen activation or the other stages of adhesion formation.

Clinicopathologic and prognostic features in appendiceal malignancies: does tumor invasiveness matter?

OBJECTIVES: To evaluate the survival rates of appendiceal tumors and prognostic factors affecting survival. MATERIAL AND METHODS: Demographic features, tumor characteristics and pre- and post-operative outcomes of the patients were analyzed retrospectively. The study was performed according to the Helsinki declaration. RESULTS: Twenty-three of the 2840 specimens were investigated prospectively. Median age of the patients was 28 (range: 1-89) years, with a male (n= 1730, 60.9%) to female (n= 1110, 39.1%) ratio of 1.55. Pediatric group did not present appendiceal malignancy. Carcinoid tumors were reported in 17 (0.59%) and adenocarcinoma was reported in 6 (0.20%) patients. Multivariate analyses of the subtypes showed serosal invasion as an independent risk factor for mucinous and non-mucinous adenocarcinoma (HR: -2.70, 95% CI: 0.006-0.755, p= 0.029). Median follow-up time was 48 months (range: 28-61 months) and disease specific survival rates of carcinoid tumors, mucinous- and non-mucinous adenocarcinomas were 36(95% CI 32-40), 30 (95% CI 13-46), 43 (95% CI 30-55) months, respectively (p= 0.749). Factors affecting survival in the univariate analyses were advanced tumor stage, serosal invasion and tumor invasion depth. In multivariate analyses, tumor invasion depth was the only independent prognostic factor with poor survival rates in all subtypes of appendiceal malignancies (HR= 1.31 (95% CI: 1.01-13.5), p= 0.047). CONCLUSION: Tumor subtype and tumor invasiveness are important risk factors for survival. Besides other treatment modalities, appendectomy still remains the survival benefit with better clinical outcomes.

Clinicopathologic and prognostic features in appendiceal malignancies: Tumor invasiveness matters.

OBJECTIVE: Appendiceal tumors are rare and mostly present as acute appendicitis. Its estimated lifetime prevalence has been reported as 8%, and the annual incidence is approximately 0.1% in Western countries. The only treatment approach is still surgery, but surgical management still remains unclear in appendiceal malignancy. MATERIAL AND METHODS: Histopathological examination of 2840 specimens obtained from patients who underwent appendectomy between January 2012 and December 2015 was investigated. Data from 23 patients diagnosed with the malignancy had been analyzed in terms of age, gender, and preoperative and postoperative clinical parameters. The overall survival rates of the patients and prognostic parameters affecting survival were also evaluated. Statistical analyses were performed using the SPSS software. The study was performed according to the Declaration of Helsinki. RESULTS: The overall median age of the patients was 28 years with a male/female ratio of 1.55. Pediatric group between 1 and 6 years, late pediatric group between 7 and 11 years, and adolescent group between 12 and 17 years did not present appendix tumors. Carcinoid tumors were reported in 17 patients. Adenocarcinoma of the appendix was reported in 6 patients. Patients with carcinoid tumors were significantly younger than those with adenocancer (p=0.01). The mean tumor size of the carcinoid group was significantly smaller than that of the adenocancer group (p=0.02). Patients with adenocancer were significantly more likely to have tumor extension beyond the appendix (p=0.05). All patients in the adenocancer group and 4 patients in the carcinoid group with mesoappendix invasion underwent right hemicolectomy. Univariate analyses demonstrated that serosal invasion, advanced tumor stage, and tumor invasion depth were associated with poor survival rates. CONCLUSION: Tumor subtype and tumor invasiveness are important risk factors for survival in appendiceal malignancies. Appendectomy alone presents satisfactory results, but complete staging of the tumor should always be considered. In addition, surgical choice is not presented as an effective factor for improved clinical outcomes and survival rates. Further prospective studies are needed to evaluate the proper staging of the tumors.

A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''.

OBJECTIVE: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment. MATERIAL AND METHODS: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated. RESULTS: The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period. CONCLUSION: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.

Thoracoscopic vagal-sparing esophagectomy and colonic interposition for caustic stricture.

Minimally invasive esophagectomy is an increasing trend in surgery. Thoracoscopic esophagectomy is applicable and an alternative procedure to conventional esophagectomy in patients especially with end-stage benign diseases like caustic stricture. A 33-year-old female patient was admitted to the department of general surgery with dysphagia. The patient was suffering from caustic stricture due to ingestion of hydrochloric acid. A totally thoracoscopic and laparoscopic vagal-sparing esophagectomy and colonic interposition was performed. As a more physiologic alternative, vagal-sparing esophagectomy is the ideal operation for these patients.

Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients?

Balneotherapy or spa therapy is usually known for different application forms of medicinal waters and its effects on the human body. Our purpose is to demonstrate the effect of balneotherapy on gastrointestinal motility. A total of 35 patients who were treated for osteoarthritis with balneotherapy from November 2013 through March 2015 at our hospital had a consultation at the general surgery for constipation and defecation disorders. Patients followed by constipation scores, short-form health survey (SF-12), and a colonic transit time (CTT) study before and after balneotherapy were included in this study, and the data of the patients were analyzed retrospectively. The constipation score, SF-12 score, and CTT were found statistically significant after balneotherapy (p < 0.05). The results of our study confirm the clinical finding that a 15-day course of balneotherapy with mineral water from a thermal spring (Bursa, Turkey) improves gastrointestinal motility and reduces laxative consumption in the management of constipation in middle-aged and elderly patients, and it is our belief that treatment with thermal mineral water could considerably improve the quality of life of these patients.

Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa.

AIMS: To evaluate association between duodenogastric reflux and early gastric mucosal changes before and after the cholecystectomy procedure. MATERIALS AND METHODS: Patients were evaluated with preoperative and postoperative endoscopy and endoscopic biopsy. Demographic and clinical characteristics, histological parameters, presence of duodenogastric reflux, and Updated Sydney scores were noted. RESULTS: A total of fifty patients who obeyed the follow-up were enrolled into the study. Median age of the patients was 43 years (range 25-84). Male-female ratio was 0.51 (17/33). Duodenogastric reflux % and Updated Sydney scores before and after cholecystectomy were 24 (48%) versus 39 (78%) and 2.38 ± 2.21 versus 3.46 ± 3.05, respectively (p = 0.001, p < 0.000). Mucosal inflammation degree showed significant increase in 15 (30%) patients, decrease in 7 (14%) patients and equality in 28 (56%) patients (p = 0.037). Neutrophil activation degree was significantly higher in 21 (42%) patients, lower in 5 (10%) patients after the surgery (p = 0.005). Postoperative glandular atrophy degree was also higher in 13 (26%) patients and equal in 37 (74%) patients (p = 0.001). Pre- and postoperative degree of intestinal metaplasia and H. pylori density did not any show significant difference (p = 0.157, p = 0.248, respectively).There were significant positive correlation between postoperative H. pylori infection and mucosal activity, inflammation, atrophy and intestinal metaplasia. CONCLUSION: Cholecystectomy is a potent inducer of pathologic duodenogastric reflux. Early onset of duodenogastric reflux and underlying H. pylori gastritis cause early gastric mucosal injury following cholecystectomy procedure by interacting collectively.

Challenging management of obturator hernia: a report of three cases and literature review.

Obturator hernia (OH) is a rare condition with high rates of morbidity and mortality. While diagnosis is difficult, surgery is the definitive treatment. Intestinal obstruction is the most common symptom upon admission. In addition, small-bowel obstruction is documented in more than half of OH patients. Advanced age, intestinal obstruction, bowel perforation, comorbid diseases, and clinical deterioration are risk factors for higher rates of mortality. The aim of the present report was to document clinical and surgical management of 3 female patients, each over 80 years of age, admitted to the emergency surgery department with intestinal obstruction and OH.

Can outcome of pancreatic pseudocysts be predicted? Proposal for a new scoring system.

BACKGROUND: The spontaneous resolution rate of pancreatic pseudocysts (PPs) is 86%, and the serious complication rate is 3-9%. The aim of the present study was to develop a scoring system that would predict spontaneous resolution of PPs. METHODS: Medical records of 70 patients were retrospectively reviewed. Two patients were excluded. Demographic data and laboratory measurements were obtained from patient records. RESULTS: Mean age of the 68 patients included was 56.6 years. Female:male ratio was 1.34:1. Causes of pancreatitis were stones (48.5%), alcohol consumption (26.5%), and unknown etiology (25%). Mean size of PP was 71 mm. Pseudocysts disappeared in 32 patients (47.1%). With univariate analysis, serum direct bilirubin level (>0.95 mg/dL), cyst carcinoembryonic antigen (CEA) level (>1.5), and cyst diameter (>55 mm) were found to be significantly different between patients with and without spontaneous resolution. In multivariate analysis, these variables were statistically significant. Scores were calculated with points assigned to each variable. Final scores predicted spontaneous resolution in approximately 80% of patients. CONCLUSION: The scoring system developed to predict resolution of PPs is simple and useful, but requires validation.

Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study.

OBJECTIVE: This study was designed to compare the efficacy of crystallized phenol method with Limberg flap in pilonidal sinus treatment. MATERIAL AND METHODS: Patients with a diagnosis of pilonidal sinus disease treated with surgical excision + Limberg rhomboid flap technique and crystallized phenol method between 2010-2011 in the Sevket Yilmaz Training and Research Hospital, Department of General Surgery were evaluated retrospectively. Patients' age, sex, length of hospital stay, complications and recurrence rates were evaluated. RESULTS: Eighty eight percent of patients were male and mean age was 26.84±6.41 in the Limberg group, and 24.72±5.00 in the crystallized phenol group. Sinus orifice locations and nature, and duration of symptoms before surgery were similar in the two groups. Length of hospital stay in the Limberg group was 1.46±0.61 days; whereas all patients in the crystallized phenol group were discharged on the same day. Infection, hematoma, wound dehiscence, and cosmetic problems were significantly higher in the Limberg group. There was no difference between the two groups in terms of recurrence and seroma formation. CONCLUSION: The less invasive method of crystallized phenol application may be an alternative approach to rhomboid excision and Limberg flap in patients with non-complicated pilonidal sinus disease, yielding acceptable recurrence rates.

The effect of glutamine on oxidative damage in an experimental abdominal compartment syndrome model in rats.

BACKGROUND: The aim was to investigate whether or not glutamine, an antioxidant effective amino acid, improves the reperfusion-induced oxidative injury of abdominal hypertension. METHODS: Wistar Albino rats were used. Group 1: Abdominal compartment syndrome alone: With the rats under anesthesia, intraabdominal pressure was obtained. Three days later, the rats were sacrificed, and intestine, lung and liver samples were removed for determination of tissue malondialdehyde (MDA) and glutathione (GSH) levels as oxidative injury parameters and of myeloperoxidase (MPO) activity as an inflammatory parameter. Trunk blood was analyzed for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Group 2: Abdominal compartment syndrome and glutamine: intragastric glutamine was given for seven days before and three days following establishment of the abdominal compartment syndrome model. The same examination procedure was then performed. Group 3: Glutamine administration alone. Group 4: Control group. RESULTS: Intraabdominal pressure significantly increased the intestine, lung and liver MDA levels and MPO activities in comparison to the control group. Glutamine was associated with decreased MDA levels and MPO activities and increased GSH levels. CONCLUSION: Glutamine appears to have protective effects against reperfusion-induced oxidative damage via its anti-inflammatory and antioxidant effect.

Intestinal Langerhans cell histiocytosis-like lesion in an adult presented with diverticulitis: a reactive or neoplastic condition?

The involvement of the gut by Langerhans cell histiocytosis (LCH) is very rare in adults; however this is usually observed with a disseminated disease in children. We report a 75-year-old male patient who underwent right hemicolectomy for a complicated intestinal diverticular disease. The surgical specimen revealed LCH-like proliferative lesion associated with diverticulitis. The overall morphological and immunohistochemical findings are indistinguishable from LCH. Systemic scans and subsequently performed bone marrow biopsies were free of disease. Although the HUMARA clonality assay cannot be assessed, the lack of evidence of LCH progression or disease elsewhere in the whole body strongly supported the possibility of an atypical reactive phenomenon probably due to the underlying intestinal diverticular disease. Therefore, it is important to avoid diagnosing such a unifocal Langerhans cell proliferation as LCH in patients with underlying pathologies in the absence of systemic involvement. Therefore, without knowledge of clonal status of a unifocal Langerhans cell proliferation, we recommend using the terminology of LCH-like lesion.

Esophageal perforation due to inadvertent swallowing of a dental prosthesis.

Intentional or inadvertent swallowing of foreign bodies can lead to severe complications in the gastrointestinal tract, primarily in the esophagus, and requires an urgent approach. In children, coins are the most commonly seen foreign bodies in the esophagus. However, in adults, the solid components of meals, like bones, and in the elderly population dental prostheses are the most frequently observed ingested foreign bodies. Even though a swallowed dental prosthesis is usually seen as a geriatric problem, esophageal obstruction and/or perforation can occur in any denture user in any age group. Thus, the aim of this report was to present one of these interesting cases of esophageal perforation due to a partial denture ingestion and its treatment in a 32-year-old male.

[Case report: primary splenic hydatidosis]. / Olgu Sunumu: primer dalak kist hidatigi.

Hydatidosis, caused by Echinococcus granulosus is still an important problem in endemic areas as Middle and Eastern Europe including Turkey, South America, Avustralia, New Zealand and South Africa. Hydatid disease affects more common liver and lung. Isolated splenic hydatidoses are quite rare in the medical literature. Here we report a case of isolated primary splenic hydatid cyst which is treated by splenectomy.

Femoral artery occlusion secondary to a spontaneously "migrated" hip prosthesis: case report.

A 77-year-old male patient was admitted to the hospital with a worsening acute ischemia of the left lower extremity. The patient, who had a coxarthrosis and was being followed by the orthopedic clinic, had undergone a total hip prosthesis, with a revision performed at the sixth month of its placement. The physical examination revealed the absence of the femoral, popliteal and distal pulses of the left lower extremity. The left hip movements were painful and limited in external rotation posture. Doppler ultrasonography showed an acute occlusion of the left common femoral artery due to the dislocated hip prosthesis, and right-to-left femorofemoral expanded polytetrafluoroethylene graft bypass was carried out. After successful surgery and an uneventful postoperative period with palpable femoral and popliteal pulses, the patient was put on low molecular weight heparin and referred to orthopedics once the ischemia had subsided with the intervention. Case reports regarding occlusions due to migration of total hip prosthesis are rare in the literature. The emphasis of this case report is to describe one such case.

Biliary peritonitis due to "fallen" hydatid cyst after abdominal trauma.

Hepatic hydatid cysts may cause serious complications. Intraperitoneal rupture of hepatic hydatid cyst is rarely seen and the prognosis can be fatal. By experience, we know that it might be difficult to diagnose an unruptured cyst expulsed into the peritoneal cavity. In this report, we present the case of a 54-year-old man with an intraperitoneal cystic mass of 10 cm of diameter which had extruded out from the liver due to a blunt abdominal trauma.

Severe hyperthyroidism requiring therapeutic plasmapheresis in a patient with hydatidiform mole.

A 38-year-old woman had a 4-week history of vaginal bleeding, heat intolerance and palpitations. Levels of beta-human chorionic gonadotropin and thyroid hormones were abnormally high. After ultrasound diagnosis of a molar pregnancy, evacuation of the mole was planned with preoperative treatment involving the use of antithyroid drugs and plasmapheresis. Plasmapheresis was used to prepare for surgery in our patient who needed more rapid hormonal control. In conclusion, early diagnosis of molar pregnancy results in decreased incidence of significant complications related to hyperthyroidism.