Comparison of the impact of open and laparoscopic inguinal hernia operations on male sexual function and pain during sexual activity.

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p < .001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p < .001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p = .001 for the open group and p < .001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p = .002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group.

Does transverse colon cancer spread to the extramesocolic lymph node stations?

BACKGROUND: Transverse colon cancers show behavioral differences in terms of the involvement of extramesocolic lymph nodes since they are closely related to all three embryological planes. These tumors have also been observed in the gastroepiploic-omental (GEOM) region, outside their usual regional areas. We will evaluate this new metastatic route in our own cases. METHODS: Thirty-four patients (16 female, 18 male) that presented to our clinic with hepatic flexure, transverse colon, and splenic flexure cancer between October 2011 and May 2017 were included in the study. Type of surgery, histopathology, and factors causing metastasis, morbidity, and mortality were evaluated. RESULTS: Cancer was located in the transverse colon in 20 patients (58.8%), hepatic flexure in 10 (29.4%), and splenic flexure in four (11.7%). Lymph node positivity in the GEOM region was present in four patients: in the infrapyloric region and pancreatic head, close to the hepatic flexure in three patients; and the midline of GEOM, close to the inferior body of the pancreas in one patient. Perineural invasion (p < .05) and N stage (p < .05) were associated with GEOM region metastasis. Tumor localization and age significantly increased pleural effusion. CONCLUSIONS: In transverse colon and both flexural tumors, we recommend planning the surgery according to the localization of the tumor and including the GEOM, infrapyloric and infrapancreatic areas. It is possible to discuss whether to perform extended excision for all or only selected patients. The best approach seems to be to evaluate the co-factors to manage these patients.

The rising trend of papillary carcinoma in thyroidectomies: 14-years of experience in a referral center of Turkey.

BACKGROUND: During the past 25 years, the incidence of thyroid papillary carcinoma (TPC), especially the micropapillary subtype, has been increasing in different countries worldwide. The rise in the rate of thyroid malignancies were also determined in Turkey in the last two decades. This fact was attributed to the Chernobyl accident because Turkey is one of the affected countries by the radioactive fallout. The aim of this study was to assess the changes in the parameters of the thyroid and put forth the reasons in a 14-year period. METHODS: The patient records, demographic and malignancy characteristics, and operations of 1,585 patients who had a thyroidectomy from 1996 to 2009 were reviewed retrospectively. The study was divided in two equal time periods for comparison of data. RESULTS: A total of 216 thyroid carcinomas (13.6%) were diagnosed in the study period. There was a significant increase in the frequency of papillary (P <0.023) and micropapillary (P <0.001) carcinomas when the two different time periods were compared. The rate of follicular, medullary and other types of malignancies did not change. In the second period (2003 to 2009) of analysis, the rate of micropapillary carcinoma (P = 0.001) and within male (P = 0.031) and female (P <0.001) genders, application of total thyroidectomy (p = 0.029), and multicentric disease (P = 0.015) increased significantly. A slight decrease in the mean age of the whole number of patients and patients with papillary and micropapillary carcinomas (P >0.05) was observed. The increased number of TPC >10 mm was insignificant. Geographic region and age specific malignancy increase was not determined. CONCLUSIONS: Micropapillary carcinoma has become a dominant type of thyroid malignancy in Turkey. The main reasons of this transition were mandatory iodization and much higher application of total thyroidectomy in surgery. Improvement in healthcare and diagnostic techniques are the complementary factors. Due to its lack of molecular and genetic basis from the perspective of thyroid cancer, the Chernobyl disaster has lost its importance in Turkey.

The revised Acute Physiology and Chronic Health Evaluation System (APACHE II) is more effective than the Glasgow Coma Scale for prediction of mortality in head-injured patients with systemic trauma.

BACKGROUND: The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. Nevertheless, the necessity of using a more complex system than GCS has been questioned recently. The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS. In addition, it is thought to be superior to GCS due to recognition of increasing age and significant chronic health problems, which adversely affect mortality. METHODS: This retrospective study included 266 patients (195 males, 71 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2003 and 2004. RESULTS: Mortality increased in the elderly group (p<0.001). Mean survival score in APACHE II was 38.0 and death score was 68.7 (p<0.001); these values in GCS were 10.4 and 6.3, respectively (p<0.001). APACHE II at the cut-off point was better than GCS in the prediction of death and survival in patients (p<0.01). The area under the receiver operating characteristic curve for sensitivity and specificity was larger in APACHE II (0.892+/-0.028) than GCS (0.862+/-0.029). CONCLUSION: For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.

Did ileal knotting trigger labor or did labor cause ileal knotting? Report of a case.

Ileal knotting is a rare but serious complication of pregnancy, with relatively high maternal and fetal mortality. We report a case of ileal knotting with complications in a pregnant woman without any history of abdominal or pelvic surgery. To our knowledge, there is no other report in the international literature. Thus, the possibility of ileal knotting should be borne in mind when investigating epigastric pain in a pregnant woman without any history of abdominal or pelvic surgery, even after the onset of labor pains. Delayed surgical intervention can result in maternal and fetal mortality.

Conservative management of hemorrhoids: a comparison of venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy.

PURPOSE: To compare the results of the conservative management of hemorrhoids between venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy, in terms of the subjective and objective outcome of patients after a follow-up period of 2 years. METHODS: One hundred and twenty-six patients who suffered from 1st-and 2nd-degree hemorrhoids were divided into 2 groups. The first (n = 64) and second (n = 62) groups underwent venotonic flavonoid MPFF (VF) and sclerotherapy (SCL). The Average Symptoms Score (ASS), Average Anascopy Score (AAS) and the subjective scale were used to assess the success of the treatments. RESULTS: A total of 113 patients agreed to participate in the follow-up study. ASS and AAS decreased in both of the groups in the first three visits (P < 0.05). At the end of the second visit, ASS and AAS significantly declined in the VF group. In addition, ASS and AAS decreased to the nadir level in the groups at the end of the 26th week. During the remaining time of the follow-up period, ASS showed a significant rise pattern in the VF group in comparison to the SCL group. The resolved and improved rate was significantly higher in the SCL group at the end of the study (P < 0.05). CONCLUSIONS: Sclerotherapy was a more efficient treatment modality than VF in the long-term follow-up. SCL also had an acceptable success rate in the short-term follow-up.

Serum tumor marker CA19-9 in the follow-up of patients with cystic echinococcosis.

BACKGROUND: The aim of this study was to compare results of the determination of carcinoembryonic antigen, carbohydrate antigens, alpha-fetoprotein, and human chorionic gonadotropin before and after surgical and pharmacologic treatment in patients with cystic echinococcosis (CE). METHODS: Serum samples were obtained from 40 CE patients (all with cysts in the liver) and from 10 sex- and age-matched healthy donors (control group). Serum samples were drawn (1) before (presurgical group) and after (postsurgical group, including a 3-month cycle of albendazole) surgical and pharmacologic treatment. Serum tumor markers were measured, and indirect hemagglutination assay was performed. RESULTS: In 90% of confirmed cases of CE, indirect hemagglutination assay was positive. Mean (SD) serum CA19-9 concentrations for all patients in the presurgical and postsurgical groups were 45.1 +/- 30 kU/L and 17.02 +/- 11 kU/L, respectively. CA19-9 concentrations were significantly greater in CE patients in the presurgical compared with the control group. Also, increased CA19-9 concentrations decreased significantly in the postsurgical compared with the presurgical group. CONCLUSIONS: A significant decrease in serum CA19-9 concentrations after surgical and pharmacologic therapy was demonstrated in the clinical follow-up of patients with CE (patients were tested 3 months after surgery). If our findings are confirmed and more-sensitive methods are developed for measuring serum CA19-9 concentrations, new and interesting perspectives will be gained for the monitoring and treatment of patients with CE.

Primary hydatid cyst of the breast with elevated CA 19-9 level.

Breast masses secondary to hydatid cyst disease are placed on the differential diagnosis of breast tumors under guidance of the literature. In addition to their characteristic appearance on mammography, many specific parameters for diagnosis are required. In this report, the relation of serum CA 19-9 levels to the primary breast cyst hydatid was evaluated in both preoperative and postoperative periods.

V-Y advancement flap closures for complicated pilonidal sinus disease.

BACKGROUND AND AIMS: Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study. PATIENT AND METHODS: Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V--Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16). RESULTS: None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline. INTERPRETATION AND CONCLUSION: Routine application of suction drains is not recommended after V--Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.

Improvement of vertical banded gastroplasty by strict dietary management.

BACKGROUND: Vertical banded gastroplasty (VBG) has been found to reduce BMI significantly during the first postoperative year. However, the same trend in weight loss has not been established thereafter. The purpose of this study was to evaluate the effects of our dietary program on morbidly obese patients treated with VBG. METHODS: A prospective evaluation of 40 obese patients (25 female, 15 male) undergoing VBG over a 3-year period was undertaken. RESULTS: The age range was 24-57 (median 38) years, mean weight 133+/-2 SD kg, and mean BMI 45+/-6.4 SD kg/m2. After VBG, a special follow-up program was applied to patients. All patients (100%) were available for follow-up. Operative mortality was zero. 4 patients developed an early postoperative complication, and 1 patient was re-operated because of staple-line disruption 8 months after VBG. BMI decreased to 34+/-3.2 after 12 months, 27+/-1.3 after 24 months, and 28+/-1.4 after 36 months. All patients showed weight loss after VBG, and the weight loss continued with the strict follow-up program during a 3-year period, except in 1 patient who regained the weight lost despite an intact staple-line and stoma. CONCLUSION: Our policy for patients after VBG appears to be effective.

Retrorectal benign cystic teratoma misdiagnosed with high lying pararectal abscess.

A case of presacral teratoma with abscess formation is presented in this report. Teratomas, like the chordomas and dermoids, constitute the largest group of retrorectal tumors. Their presentation has varied. Dependent to unique localization, cystic teratoma complicated with abscess formation are misdiagnosed as high lying pararectal abscesses. Both diagnostic and therapeutic difficulties were evaluated with literature review.