Surgical management of anorectal foreign bodies.

PURPOSE: Anorectal foreign bodies (AFBs) inserted into anus constitute one of the most important problems needing surgical emergency due to its complications. We describe our experience in the diagnosis and treatment of AFBs retained in the rectosigmoid colon. MATERIALS AND METHODS: Between the years 2006 and 2015, a total of 11 patients diagnosed with AFBs were admitted to an emergency room and general surgery clinics. They were diagnosed and treated in four different hospitals in four different cities in Turkey. Information on the AFBs, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. RESULTS: Eleven patients were involved in this study. All patients were male with their mean age was 49.81 (range, 23-71) years. The time of the presentation to the removal of the foreign bodies ranged between 2 h and 96 h with a mean of 19.72 h. Ten patients inserted AFBs in the anus with the purpose of eroticism but one patient's reason to relieve constipation. The objects were one body spray can, two bottles, three dildos, two sticks, one water hose, one corncob, and one pointed squash. Three objects were removed transanally after anal dilatation under general anesthesia. Eight of the patients required laparotomy (milking, primary suture, and colostomy). Five of the patients had perforation of the rectosigmoid colon. Abdominal abscess complicated extraction in one patient after the postoperative period. The hospitalization time of the patients was 6.18 (1-16) days. None of the patients died. CONCLUSIONS: A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.

Do the calcifications in the thyroid gland predict malignancy?

BACKGROUND: The purpose of this study was to determine the relationship between calcifications in the thyroid gland and malignant thyroid lesions. METHODS: From June 2005 - May 2010, 169 patients, who had been operated on for thyroidectomy, were evaluated. The demographic findings were analyzed with regard to ultrasonographic and histopathologic calcifications. The relationship between calcifications and malignant and benign thyroid lesions was statistically determined by SPSS 10.01 version of Z-test and Chi-square test. RESULTS: Microcalcifications were found in 54 patients (31.95 %). Macrocalcification was found in one patient (0.59 %).Malignancy was determined in 29 patients (17.16 %). The rate of malignancy in patients with calcifications was 17/55 (30.9 1%). The diagnosis was nodular colloidal goiter in 38 patients (38/55, 69.09 %) with calcifications. The rate of calcification in malignant patients was 17/29 (58.62 %). The rate of malignancy in patients without calcification was 12/114 (10.52 %). The difference between the rate of malignancy in patients with calcification and the rate of malignancy in patients without calcification was statistically significant (Z-test, p < 0.001). CONCLUSION: Microcalcifications of the thyroid gland could predict malignant thyroid disease. They should be strictly evaluated by all thyroid cancer diagnostic modalities and surgical treatment should also be considered (Tab. 4, Ref. 29).

Is advanced age a significant risk factor for laparoscopic cholecystectomy?

AIM: have been a few reports about the outcome of laparoscopic cholecystectomy (LC) in the elderly patients. The aim of this study was to assess if morbidity and mortality may be increased in the geriatric patients because of high incidence of co-morbidity. METHODS: From November 2000 to January 2009, 146 patients aged 60 years and older who underwent LC were reviewed. Patients were placed into two groups by ages: Group A (age = 60-74 years, N.=126), Group B (age ≥ 75, N.=20). RESULTS: One hundred forty six patients underwent LC for benign gallbladder disease during this study period There was no difference in operative time, ASA, distribution of sex between the two groups. Most patients were treated with LC for symptomatic cholelithiasis (82.5%) in both groups. There were sixty eight cases (53.96%) in the Group A and 14 (70%) patients in the Group B had co-morbid diseases (P>0.005). Conversion rates and morbidity was not different significantly according to ages for either group (P>0.05). The rate of conversion to OC was 9.5% in the Group A and 5% in the Group B. Five complications were occurred in the four patients. There was only one bile duct injury in the Group A. Conversion rates and postoperative complications were not affected by gender and co-morbid diseases (P>0.05) in our study whereas acute cholecystitis were found as a risk factor for conversion to open surgery and complications according to the cases preoperatively diagnosis (P=0.001). CONCLUSION: LC should be recommended with acceptable morbidity and mortality in the elderly. Morbidity and conversion to OC are not increased with advanced age even in the extremely elderly patients. Acute cholecystitis is correlated with a high risk factor for morbidity and conversion to OC.

Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.

Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study.

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

Giant adrenal myelolipoma: case report and review of the literature.

Myelolipoma is a tumor-like growth composed of mature fat tissue and bone marrow elements. It occurs in the adrenal gland or as an isolated soft tissue mass. It may be associated with endocrine disorders such as hermaphroditism, Cushing's disease, Addison's disease and obesity of unknown cause. These lesions rarely measure more than 5 cm in diameter, although giant tumors have been reported in the literature. The fifth largest surgically resected adrenal myelolipoma in the literature is reported and its clinical associations and, macroscopic and microscopic features are discussed.

The effect of albendazole on the prevention of secondary hydatidosis.

BACKGROUND/AIMS: Secondary hydatidosis and recurrence are serious complications in hydatid surgery. Although medical treatment and current surgical techniques are more effective in the prevention of cyst formation resulting from spillage of cystic liquid, secondary hydatidosis is still surgically important. Albendazole, a derivative of benzoimidazole, is the most commonly used drug in the medical treatment of echinococcosis. The effectiveness of pre-operative prolonged or single dose applications is supported by the literature. METHODOLOGY: Twenty-two cases of hepatic hydatidosis are evaluated and treated by surgery. Perioperative albendazole treatment was given in a dose of 12-15 mg/kg/day in 4 divided doses. The treatment began 5-20 days before the surgery and continued 3-7 months in a cyclic monthly form, until latex agglutination tests were negative. In the postoperative period, hematological, ultrasonography and computed tomography scan evaluation was carried out. The follow-up period for 21 patients was 6-31 months (mean: 20.52 months). RESULTS: There was no secondary hydatidosis, recurrence or mortality in this study. Early and late morbidity rates were 4.54% and 13.63% respectively. CONCLUSIONS: Our results support that perioperative albendazole treatment is effective in the prevention of secondary hydatidosis.

Effect of albendazole sulfoxide solution on the scolices and the hepatobiliary system.

The use of scolocidal solutions in the hepatobiliary system may result in caustic sclerosing cholangitis. In this study, the effectivenes of a biological metabolite of albendazole, albendazole sulfoxide, on scolices and the hepatobiliary system was evaluated. In the in vitro study, it was found that 100 microg/ml albendazole sulfoxide solution had strong scolocidal effect in 15 min. In the in vivo study, two experimental groups, each consisting of 8 rabbits aged 3-4 months and weighing 2,500 +/- 250 g, 100 microg/ml albendazole sulfoxide and normal saline were given into the biliary tract. ALP, GGT, SGOT and SGPT values on days 7, 30 and 60 were not found to be significantly increased compared to preoperative values. Total bilirubin values were high in the working group 7 and 30 days postoperatively and on day 30 in the control group, returning back to normal levels on day 60 in both groups. Histopathological evaluation of the liver parenchyma and the biliary system on day 60 revealed no differences between the groups. Consequently, albendazole sulfoxide solution may be used intraoperatively for scolocidal purposes.

Intracystic application of mebendazole solution in the treatment of liver hydatid disease. Preliminary report of two cases.

Mebendazole, a derivate of benzimidazole, is commonly used for the treatment of hydatid disease in patients at high operative risk and/or to prevent secondary hydatidosis. In this study, 2 cases of liver hydatid disease, in which mebendazole was used both orally and for intracystic application are presented. These cases have been treated by percutaneous drainage and videolaparoscopic methods. Mebendazole solution at a concentration of 2.4 micrograms/ml was injected into the cyst. For a period of 6 months 50 mg/kg/day oral treatment was given. At the end of a 6- to 9-month period, the total recovery was observed. This is the first report of mebendazole pair-treatment in the literature.

The effect of intraoperative mebendazole-albendazole applications on the hepatobiliary system.

Caustic sclerosing cholangitis occurs with the use of scolicidal solutions in liver hydatid disease draining into the biliary system. In this study, we investigated the effectiveness of benzimidazole solutions, their in vitro scolicidal effects and the histopathological changes in the hepatobiliary system due to their intraoperative use. It was found that 5 mg% mebendazole and 1 mg% albendazole have strong scolicidal effects. In an in vivo study, under general anesthesia, 5% mebendazole in group I, 1% albendazole in group II and normal saline in group III were injected into the biliary system of rabbits. Liver biochemical tests showed no significant changes. More elaborate ductal mucosal proliferation, ductal dilatation and periductal fibrosis were found in group I compared with group II in biopsies taken on the 60th day. The biopsies of group III were normal.