Comparison of the effectiveness of two treatment modalities for chronic anal fissure: Botox versus sphincterotomy.

OBJECTIVES: Anal fissure is a common health problem that affects the quality of life of young patients. The aim of our study was to benchmark results of lateral internal sphincterotomy (LIS) and botulinum toxin injection in the treatment of chronic anal fissure. MATERIAL AND METHODS: This multi-center, retrospective study used data from 135 chronic anal fissure patients. Patients' demographic features, clinical findings, fissure characteristics, post-defecation pain score, rectal bleeding or pruritus, and treatment satisfaction scores were recorded. Patients' data were collected from the hospital records and patients with all of this data available were called and invited to the hospital for examination. RESULTS: Seventy-four LIS and 61 botulinum toxin applied patients were included. Symptom duration, hospitalization period, and duration of remission of complaints after the treatment were significantly higher in the LIS group (p<0.001). However, pruritus in anus and relapses were found to be higher in the botulinum toxin group (p=¬ 0.04 and p= 0.043, respectively). Abscess and fistula were observed in one patient's perianal region in the LIS group, and an abscess was observed in one patient in the botulinum toxin group. There was no significant difference in treatment satisfaction rates and postoperative complications. CONCLUSION: Botulinum toxin yields satisfying results that are comparable to LIS. Patient selection may help mitigate this disease and allow it to be considered a good alternative option to surgery.

Effects of boric acid-linked ampicillin on the rat intra-abdominal sepsis model.

The aim of this study was to determine efficiency of a new molecule that was obtained by linking boric acid with ampicillin in treating intra-abdominal infection.Following intraperitoneal E. coli injection totwenty-one female Wistar albino rats, group 1 was administered boron-linked ampicillin, group 2 was administered only ampicillin and group 3 was injected intraperitoneally with physiological serum. IL-6, and a white blood cell analysis was performed from the blood before and on the seventh day of treatment.No statistically significant difference in blood WBC levels after treatment was found among the groups. There was no statistically significant difference in the IL-6 values of group 2 and group 3 before and after the treatment (p=0.195 and 0.193, respectively); however, the reduction in the serum IL-6 values of group 1 was statistically significant (p=0.003).Boric acid-linked ampicillin is a more effective intra-abdominal infection treatment compared with ampicillin alone.

A survey of current approaches to thyroid nodules and thyroid operations.

INTRODUCTION: Thyroid nodules are commonly seen. Our aim is to learn the behaviors and operational attitudes of surgeons approaching the thyroid nodules. In a literature search, our study is the first and only study performed merely on surgeons. MATERIALS- METODS: This cross-sectional study was done between June 2014-January 2015. The questionnaire consists of 25 questions. Initially, general questions consisting of demographic findings were asked. In step 2, questions consisting of the index case and case variants were asked. Results were compared with American Thyroid Association, European Thyroid Association guidelines, and Australia survey results. In the last step, questions about thyroid operations were asked. RESULTS: A total of 301 surgeons responded to the survey. The response rate was approximately 20%. Thirty nine were female and 262 were male. For the question that asks the diameter of the thyroid nodule that will require a thyroid fine needle aspiration biopsy (TFNAB), 47.5% of the surgeons will require a TFNAB for 1-2 cm solid nodules. 40.15% of the surgeons required a TFNAB regardless of size. 46.1% of the surgeons who required a TFNAB between 1 and 2 cm solid nodules also required scintigraphy at diagnosis of suppressed TSH case variant. CONCLUSION: In this survey, we identified differences from up-to-date guidelines about approaching thyroid nodules and perioperative thyroid surgery. From our perspective, surgeons need updated training requirements. This can be done with updated seminars across the country. Thereby approaches may become standard and consequently patients may have qualified services.

Correlation of Bowel Wall Thickening Seen Using Computerized Tomography With Colonoscopies: A Preliminary Study.

PURPOSE: Bowel wall thickening (BWT) is a common finding in abdominal computerized tomography imaging (CTi). The purpose of the present study was a prospective assessment and management of patients who have BWT in abdominal CTi. MATERIALS AND METHODS: This study was conducted between January 2012 and July 2014 at Erzincan University Hospital, Turkey, with 64 patients who were admitted to the emergency and general surgery department. All of the patients had received colonoscopies due to BWT seen in abdominal CTi. RESULTS: Twenty-three (36%) female and 41 (64%) male patients were included in the study. The mean age was 56.2 years (range, 14 to 84 y). The positive predictive value of CTi for BWT was 87.5%. The positive predictive value of a CTi diagnosis of the disease according to a radiologist's report was 78.1%. Common pathologies detected by colonoscopy included neoplasia and inflammatory bowel disease. CONCLUSIONS: Diagnosis of BWT by abdominal CTi reveals pathologies in many cases. Colonoscopies will be helpful in the differential diagnosis.

Metalloproteinases and Their Inhibitors in Patients with Inguinal Hernia.

AIM: The aim of this prospective study is to investigate if there is a relationship between inguinal hernia, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs). MATERIALS AND METHODS: This case control study was performed on patients admitted to the general surgery department of Erzincan University Hospital. Four groups were created: control, indirect hernia, direct hernia, and bilateral hernia. All groups were comprised of 11 patients. Serum and tissue levels of MMP-1, MMP-2, MMP-9, MMP-13, TIMP-1, TIMP-2, TIMP-3, and hydroxyproline were evaluated. RESULTS: MMPs values were significantly high at hernia groups, especially at bilateral hernia group (p < 0.05), whereas TIMPs values were significantly low at bilateral hernia group (p < 0.05). MMPs values were increasing at hernia groups in an order as control, indirect, direct, and bilateral. TIMPs values were decreasing at hernia groups in an order as control, indirect, direct, and bilateral. CONCLUSION: Increased levels of MMP-1-2-9-13 and decreased levels of TIMP-1-2-3 may have played role in the formation of inguinal hernia. Hernia is not only a local defect, but a reflection of systemic disease. This is even more significant for bilateral hernias.

Myxofibroma of the maxilla, current concepts, and differential diagnosis.

Odontogenic myxomas represent a small portion of all odontogenic tumors. A myxoma of the bone is a rare lesion that occurs almost exclusively in the jaws. An odontogenic myxoma has a variable clinical and radiological appearance, and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups. Myxomas consist of an accumulation of mucoid ground substance with little collagen, the amount of which determines whether it is called a myxofibroma. This paper presents the case of a 39-year-old male with a solid whitish red, nonulcerative, nontender expansion of both the buccal and palatal sides of the right upper alveolar bone. Results of a radiological examination revealed a unilocular radiolucency with cortical expansion and displacement of both the right upper second premolar and the first molar. The lesion was totally excised, and the histopathological examination showed a myxofibroma. Healing was uneventful, and there was no recurrence 12 months after surgical excision. Complete removal of the tumor, leaving no remnants attached to the soft tissue or bone, should be considered because of the well-known potential of myxofibromas to recur.

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery.

Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.

Novel Approaches in Pilonidal Sinus Treatment.

Pilonidal sinus is a very common inflammatory disease of the gluteal region. The ideal method of pilonidal sinus treatment should have a low recurrence rate with minimum excision. Moreover, the treatment method should have a short hospitalization time, should let the patient return to his normal life rapidly, should cause minimum loss of labour and should result a small scar only. In the presented review, modalities in pilonidal sinus treatment in the light of current information in the literature are evaluated.

The Effects of Preoperative Endoscopic Tattooing on Distal Surgical Margin and Ileostomy Rates in Laparoscopic Rectal Cancer Surgery: A Prospective Randomized Study.

AIM: This study aimed to evaluate the effect of endoscopic marking on the distal surgical margin and ileostomy rates in laparoscopic rectal cancer surgery. MATERIALS AND METHODS: Forty patients, who underwent surgery between September 2012 and December 2013 for rectal cancer limited to or with invasion of the upper rectum, were included in the study. The distal tumor margin was marked with purified carbon particles by colonoscopy before surgery in one group (n=20); no marking was performed in the second group (n=20). Patients were assigned randomly to each group. Laparoscopic anterior or low-anterior resection was performed in all patients. Demographic and operative data, pathology results, morbidity, and ileostomy rates were measured. RESULTS: There was no statistically significant difference in the demographic data, the tumor size, the amount of bleeding, the specimen length, the harvested lymph node number, postoperative complications, the length of hospital stay, rehospitalization, and the operation duration between groups 1 and 2, respectively. The distal surgical margin was significantly shorter in the marked group. The protective ileostomy rates were also lower in the marked group; however, the difference did not reach statistical significance. CONCLUSIONS: Preoperative endoscopic tattooing decreases distal resection margins and may reduce protective ileostomy rates in laparoscopic rectal surgery.

The effects of supplemental melatonin administration on the healing of bone defects in streptozotocin-induced diabetic rats

ABSTRACT Diabetes mellitus (DM) causes an increased production of free radicals that can impair bone healing. Melatonin is a hormone secreted mainly by the pineal gland, which participates in the neutralization process of free radicals. Objective The aim of this study was to investigate histologic and biochemical effects of supplemental melatonin administration on bone healing and antioxidant defense mechanism in diabetic rats. Material and Methods Eighty-six Sprague-Dawley male rats were used in this study. Diabetes mellitus was induced by intraperitoneal (i.p.) administration of 65 mg/kg streptozotocin (STZ). Surgical bone defects were prepared in the tibia of each animal. Diabetic animals and those in control groups were treated either with daily melatonin (250 μg/animal/day/i.p.) diluted in ethanol, only ethanol, or sterile saline solution. Rats were humanely killed at the 10th and 30th postoperative days. Plasma levels of Advanced Oxidation Protein Products (AOPP), Malondialdehyde (MDA), and Superoxide Dismutase (SOD) were measured. The number of osteoblasts, blood vessels and the area of new mineralized tissue formation were calculated in histologic sections. Results At the 10th day, DM+MEL (rats receiving both STZ and melatonin) group had significantly higher number of osteoblasts and blood vessels as well as larger new mineralized tissue surfaces (p<0.05 for each) when compared with DM group. At the 30th day, DM group treated with melatonin had significantly lower levels of AOPP and MDA than those of DM group (p<0.05). Conclusion Melatonin administration in STZ induced diabetic rats reduced oxidative stress related biomarkers and showed beneficial effects on bone healing at short term.

A Rare Case of Isolated Cystic Hydatid of Thyroid Gland.

Hydatid cysts are most frequently localized within the liver and lungs, although they can also be found in highly vascularized tissues such as the brain, muscle, heart, pancreas, adrenal, and thyroid glands.A 65-year-old female patient was admitted to our clinic with complaints of a progressively growing mass that was compressing the surrounding tissues and causing respiratory distress. The pathological result was obtained as cytic hydatid.In patients with diagnosed hydatid cysts in the liver, systemic evaluation is necessary to rule out involvement of other organs. Among patients presenting with growths located in the neck, primary hydatid cyst of the thyroid gland must be considered in endemic regions.

Gossypiboma Mimicking a Mesenchymal Tumor: A Report of a Rare Case.

BACKGROUND: Gossypiboma is the term for a surgical complication resulting from foreign materials such as a surgical sponge or gauze that was accidentally left inside a patient's body. CASE REPORT: Here, we report the case of a 62-year-old woman with gossypiboma. She underwent surgery due to an abdominal mass that was preoperatively considered a tumor. Intra-postoperatively, it was diagnosed as gossypiboma. CONCLUSIONS: For the prevention of gossypiboma during the pre-operative and post-operative periods, counting sponges and surgical equipment must be done very carefully. If there is any doubt postoperatively, direct abdominal imaging may be helpful.

Relationship between intestinal microbiota and colorectal cancer.

The human gastrointestinal tract hosts a complex and vast microbial community with up to 10(11)-10(12) microorganisms colonizing the colon. The gut microbiota has a serious effect on homeostasis and pathogenesis through a number of mechanisms. In recent years, the relationship between the intestinal microbiota and sporadic colorectal cancer has attracted much scientific interest. Mechanisms underlying colonic carcinogenesis include the conversion of procarcinogenic diet-related factors to carcinogens and the stimulation of procarcinogenic signaling pathways in luminal epithelial cells. Understanding each of these mechanisms will facilitate future studies, leading to the development of novel strategies for the diagnosis, treatment, and prevention of colorectal cancer. In this review, we discuss the relationship between colorectal cancer and the intestinal microbiota.

The effect of ozone and naringin on intestinal ischemia/reperfusion injury in an experimental model.

BACKGROUND: The aim of the study was to evaulate the effect of ozone and naringin on the intestine after intestinal ischemia-reperfusion(II/R) injury. METHODS: Thirty five rats divided into 5 groups of 7 animals: control, II/R, ozone, naringin and naringin + ozone. Only laparotomy and exploration of the superior mesenteric artery (SMA) were done in control group. In the experimental groups, SAM was occluded for 1 h and reperfused for 1 h. 15 min after ischemia, ozone (25 µg/ml, 0.5 mg/kg), naringin (80 mg/kg) and naringin + ozone(80 mg/kg + 25 µg/ml, 0.5 mg/kg) were infused intraperitoneally to each groups. Ileum tissues were harvested to determine intestinal mucosal injury and oxidative stress markers. For SMA occlusion, different than literature, silk suture binding was used. RESULTS: Oxidative stress markers were significantly low in experimental groups compared with II/R group (p < 0.05). Histopathologically, the injury score was significantly low at experimental groups compared with II/R group (p < 0.05). The lowest injury score was encountered at naringine + ozone group. CONCLUSIONS: Ozone alone or combined with naringin has a protective effect for mesenteric ischemia. Instead of using instruments such as clamps in the II/R rat model, silk binding may be used safely.

Incarceration of the hepatic lobe in incisional hernia: A case report.

INTRODUCTION: Incisional hernias are abnormal peritoneal outward pouch-like protrusions that develop due to defects that arise as a result of the disruption of the fascia's continuity after abdominal surgery. PRESENTATION OF CASE: A 77-year-old female patient presented to the emergency department of our hospital with complaints of abdominal swelling, abdominal pain, nausea and vomiting. The patient was recommended for surgery. It was decided that the primary fascia closure and onlay patch was the most appropriate approach. DISCUSSION: When the defect in the abdominal wall grows, the functionality of the related abdominal wall is disrupted thereby eliminating the dynamic structure of the abdominal wall. Incisional hernias lead to a significant number of job losses and morbidity and negatively affect quality of life. Moreover, the formations in the hernia pouch might lead to higher risk of strangulation and dysfunction. CONCLUSION: Subcutaneous herniation of the left lobe of the liver passing through the abdominal wall is a very rare condition.

Diagnostic evaluation and treatment of patients with rectus abdominis hematoma.

PURPOSE: To identify clinical characteristics, treatment modalities, and course of spontaneous rectus sheath hematoma (SRSH). In the literature, there is no prospective clinical trial that is intended for treatment in clinical research. METHODS: Seventeen SRSH patients diagnosed and treated between March 2012 and March 2014 at the general Surgery Department of Erzincan University Training and Research Hospital were included. Age, sex, weight, height, predisposing factors, comorbid diseases, Charlson index, current medical treatment, physical examination signs, imaging methods, lowest hemoglobin value, blood type, SRSH type, INR/Factor V Leiden mutation/Factor VII/Factor VIII/Factor X/Protein S/Protein C values, treatment method, transfusions hospitalization duration, and outcome were studied. RESULTS: Thirteen patients were female. The mean age was 63.3 ± 18.7 years (range, 22-87 years), and the mean BMI was 27.8 ± 3.5 (range, 20.9-33.7). Six patients had Grade I SRSH, 5 had Grade II SRSH, and 6 had Grade III SRSH. Thirteen were hospitalized for a mean duration of 9.3 ± 8.1 days (range, 1-30 days). The death rate attributable to SRSH was 5.8%. CONCLUSION: Early diagnosis of SRSH by ultrasonography and/or computerized tomography is important for a low mortality rate. Even though medical treatments are important, arterial embolization by interventional radiology, or more radical interventions such as surgery, may be required.

Rare tumors of the gallbladder: Clear cell carcinoma.

INTRODUCTION: Gallbladder cancer is a rare tumor in the gastrointestinal tract has poor prognosis, low survival and is difficult to diagnose. The most common type of gallbladder cancer is adenocarcinoma, and the incidence of clear cell carcinoma is low. Mostly, it is difficult to determine whether the isolated tumor is a primary tumor in the gallbladder or a metastatic tumor from another region. Before accepting a clear cell carcinoma as a primary gallbladder tumor, the kidneys and other possible secondary focuses are clinically considered in terms of metastases. PRESENTATION OF CASE: Here, we present a rarely seen case of gallbladder clear cell carcinoma, which was diagnosed by pathological examination after the surgery. DISCUSSION: Prior to establishing that clear cell carcinoma is a primary gallbladder cancer, it is appropriate to clinically investigate possible secondary focuses, in particular the kidneys in terms of metastasis. CONCLUSION: Our goal in presenting this case was to emphasize the importance of taking an accurate medical history in patients with clear cell carcinoma, a rarely seen gallbladder cancer.