Reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment in rats.

INTRODUCTION: Hyperbaric oxygen (HBO2) treatment results in elevated production of reactive oxygen species (ROS) that leads to cellular damage. Thymoquinone (TQ) is reported to have anti-inflammatory and antimicrobial activity and may suppress the generation of free radicals. The goal of this study is reduction of side effects of hyperbaric oxygen therapy with thymoquinone treatment. METHODS: 30 female Sprague-Dawley rats were randomly assigned to one of three groups (n = 10 per group). Group 1 represented the control group (no treatment). Group 2 was exposed to 100% oxygen at 2.5 ATA for two sessions of two hours'duration each day for five days. Group 3 was treated identically to Group 2 and was also given thymoquinone once daily at 50 mg/kg/day by oral gavage for five days, after first session of HBO2. RESULTS: LOOH and SH levels were significantly elevated in the group receiving HBO2 treatment relative to the control group rats. Fetuin A is increased during TQ treatment. LOOH and SH levels were significantly decreased in animals treated with TQ. CONCLUSIONS: Long-term and repeated HBO2 treatment leads to damage to the lung tissue. In urgent situations or cases of severe hypoxia, repeated HBO2 sessions may be necessary, and TQ antioxidant agents may be useful for prevention of HBO2-associated injury. TQ may represent a useful therapeutic option during HBO2 treatment.

Effects of thymoquinone and curcumin on the regeneration of rat livers subject to 70% hepatectomy.

PURPOSE: To investigate thymoquinone, curcumin and a combination of these two drugs were effective or not at the growth of liver. METHODS: Forty female Wistar-Albino rats distributed into five groups of eight rats each, control, thymoquinone, curcumin, and thymoquinone/curcumin groups. Pathological specimens were studied using the Ki-67 Proliferation Index(PI); and arginase(Arg), tissue plasminogen activator(tPA), ceruloplasmin(Cer) and nitric oxide(NO) were studied in biochemical analysis. RESULTS: Our results showed that Ki-67 proliferation index was low in Groups 1. The proliferation coefficient was significantly higher in the Group 2 and Group 4 than in the Group 1 and Group 3.(P < 0.001 between Groups 1 and 2, 1 and 4, and 3 and 4). There was no difference between Groups 2 and 4 (P = 1). The results of the biochemical Arg, tPA and Cer test showed statistically between the Group 1 and Group 2. NO showed significant differences Group 1 and 3. CONCLUSIONS: Thymoquinone and curcumin both have known positive effects on the organism. Histological and biochemical tests showed that thymoquinone is more effective than curcumin.

The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women.

Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.

Can ultrasonic surgical devices be used to close the appendicular stump?

Laparoscopic appendectomy is increasingly being performed because of its quick recovery time, low instance of wound infection, and early return of patients to home and work. Operating time should be short yet safe. Therefore, in this study, we compared the effects of various sealing systems on the length of surgery and examined whether these systems could be used to separate the appendix from its stump successfully. This prospective and randomized ex vivo study was conducted on 20 consecutive patients diagnosed with acute appendicitis. All patients underwent classical open appendectomy. The patients were classified into two groups according to the type of sealing system used. The LigaSure® system was used for coagulation in Group L and the Harmonic® system in Group H. After coagulation, a pressure system was used to evaluate the closure of the appendix. Results showed that the use of ultrasonic instruments alone to close the appendiceal stump caused an incomplete closure. KEY WORDS: Appendicular stump, Laparoscopic appendectomy.

Ultrasonography in diagnosis of acute appendicitis.

PURPOSE: Acute appendicitis is the most common surgical abdominal emergency. In the early diagnosis of acute appendicitis, the fact that there is no a sign which could be a reliable indicator in most of the patients increases the complications. In this study we aimed to search the relation between Ultrasonography(US) findings in patients with diagnosis of acute appendicitis and postoperative histopathologic investigation on remoced appendix.. MATERIALS AND METHODS: The files of 174 patients who came in our emergency department with lower right abdominal pain were studied retrospectively from January 2013 to May 2014. Of them, 26 patients were excluded, because these patients were not studied with US. US findings and histopathology reports of 148 patients with suspected acute appendicitis and studies preoperatively with abdominal US were enrolled. Greater than 6-mm diameter of the appendix under compression was accepted as positive sign of appandicitis in US. The demographic characteristics of the patients, US findings (acut appendicitis or not) and the pathology results were recorded on the standard proform. RESULTS: Of these 148 patients, 100 were acute appendicitis in preoperative US, and of these 100 patients, 93 histopathologic reports were acute appendicitis, 7 were normal appendices. The sensitivity of US was 75.6 % and specificity was 72 %. Positive predictive value (PPV) was 93 %, negative predictive value (NPV) was 14.6 % and the accuracy of US value was 81.7%. As a result, although US in diagnosis of acute appendicitis is a reliable technique, negative result doesn't mean no acute appendicitis. In order to determine an accurate diagnosis of acute appendicitis clinical and laboratoary findings should be assessed together. KEY WORDS: Abdominal pain, Acute appendicitis, Ultrasonography.

Minimal effective dose of povidone-iodine in abdominal surgery Our clinical experience.

UNLABELLED: The aim of this study is to evaluate the thyroid function tests in order to examine whether 10 % of Povidone-Iodine(PI), the medication we applied in 1/5 ratio diluted with 0.9 %NaCl, joins the systemic circulation during clean contaminated, contaminated and dirty operations for solid organ hydatid cysts in abdominal area to avoid abscess formation and spreading. 7 men and 6 women were included to the present study, prospectively. The mean age was 33.69(± 13.49). TSH, free T3 (fT3) and free T4 (fT4) hormone levels were measured before the operation and at the third day of postoperative period. Amount of used povidone-iodine for patients was recorded. As a result of statistical analysis applied, the preoperative and post operative values were not significantly different regarding with the measured hormone levels (preTSH vs postTSH: p= 0.984; prefT3 vs postfT3: p= 0.101; prefT4 vs postfT4: p=0.146). Thus, it has been shown that the dose we used is effective, and it does not enters at all or at quite low levels into the systemic circulation. Patients whom this application performed, abscess and intestinal adhesions have not been observed in our clinical experience. We recommend the use of suggested doses of Povidone-Iodine in the presence of intraabdominal perforation and abscess or in cases such as carrying a risk of cyst spreading to intraabdominal area in hydatid cysts. KEY WORDS: Povidone-iodine, Surgical adhesions, Surgical wound infections, Thyroid function tests.

The effects of lycopene on intestinal injury due to methotrexate in rats.

OBJECTIVE: The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx)-induced intestinal damage in rats. METHOD: Twenty-eight male Sprague Dawley rats were divided into four equal groups: control, Mtx, Lyc, and Mtx-L. CONTROL GROUP: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for 10 days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were treated with Lyc (10 mg/kg) for 10 days after a single dose of Mtx (20 mg/kg). All of the rats were euthanized using terminal anesthesia, and the intestinal tissues were removed for histological examination and for pro-inflammatory cytokine measurement (tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß)), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). RESULTS: Mtx administration increased histopathological damage and increased TNF-α, IL-1ß, TOS, TAC, and OSI levels in the small intestine tissues. Lyc therapy applied to the Mtx-L group provided significant improvement in all parameters of histopathological damage to the small intestine and significantly reduced the levels of IL-1ß, TOS, and OSI in the intestinal tissues. CONCLUSIONS: The results of this study indicate that Lyc might be useful for protecting intestinal damage induced by Mtx in rats by reducing the increased oxidative stress and pro-inflammatory cytokine (IL-1ß) levels.

Narrowing of giant gastric perforation by purse-string suture before omental plugging.

INTRODUCTION: Timely diagnosis of the gastroduodenal perforation usually allows primary repair or resection. Treatment of a large gastric perforation is more difficult than the common duodenal ulcer perforation by plugging and usually requires agastric resection. On the other hand, gastric resection fora hemodynamically compromised patient in sepsis hasa high rate of anastomotic failure and mortality. Here, we described a practical surgical technique that can avoid emergency gastric resection in such situations. PRESENTATION OF CASE: A 83 year-old female admitted with peritonitis, severe sepsis and hemodynamic instability. After the diagnosis of hollow organ perforation and supportive therapy, laparotomy revealed a delayed and large (7 cm) gastric perforation. Instead of gastrectomy, we downsized the large defect by means of a purse-string suture around the perforation and made it suitable for the application of omental plugging. DISCUSSION: The patients with poor performance status who are not suitable for the gastric resection, a free omental plug fixation to the narrowed perforation area by a purse-string suture can overcome the problem. CONCLUSION: This method can be keep in mind as a damage control surgery technique in the non-traumatic abdominal emergencies due to large gastric perforations.

Surgical treatment of hepatic hydatid cysts A retrospective analysis of 425 patients.

BACKGROUND: We aimed to retrospectively analyze patients who underwent surgical treatment in our clinic for hydatid cysts in terms of the surgical methods implemented and their results. METHODS: Archival records of the patients who underwent surgery for the treatment of hydatid cysts between 2007 and 2014 were analyzed retrospectively. RESULTS: The records of 425 patients who underwent surgery with varying ages of 16 to 88 years (mean: 44.5) were obtained. Among the patients, 33.9% (n=144) were male and 66.1% (n=281) were female. The most frequent symptoms were abdominal pain (46.4%) and dyspepsia (30.9%). About 79.5% of the patients had hydatid cysts in their livers, and 66.8% of these cysts were on the right lobe of the liver. Surgical intervention was performed on 513 cysts. The average diameter of these cysts was 8.3 cm. About 85.5% (n= 438) of the interventions implemented were partial cystectomy. Laparotomy was performed through the right subcostal incision on 81% (n=345) of the patients who underwent conventional surgery. The most frequently encountered complication was biliary fistula. The mortality rate was 0%. CONCLUSIONS: The results showed that most of the cases were uncomplicated isolated hepatic hydatid cysts frequently found on the right lobe of the liver. The most frequently implemented surgical procedure was partial cystectomy. This procedure was simple, fast and applicable for uncomplicated hepatic hydatid cysts. KEY WORDS: Hepatic hydatid cyst, Mortality, Partial cystectomy.

Isolated pneumomediastinum following laparoscopic cholecystectomy: an unpredictable situation.

Pneumomediastinum is a clinical event characterized by the presence of air in the mediastinum. Often a result of physical trauma, this condition results from air escaping from the respiratory airway and moving into the mediastinal cavity. Although rare, it can also develop following abdominal laparoscopic surgical procedures. Diagnosis is commonly made by visualizing a radiolucent airline in the mediastinum and/or surrounding the heart following a chest X-ray radiography or a thoracic CT scan. This case study describes the diagnosis, treatment and follow-up of a 51 years old female patient who developed pneumomediastinum following a laparoscopic cholecystectomy.

Effects of thymoquinone and curcumin on the regeneration of rat livers subject to 70% hepatectomy

Abstract Purpose: To investigate thymoquinone, curcumin and a combination of these two drugs were effective or not at the growth of liver. Methods: Forty female Wistar-Albino rats distributed into five groups of eight rats each, control, thymoquinone, curcumin, and thymoquinone/curcumin groups. Pathological specimens were studied using the Ki-67 Proliferation Index(PI); and arginase(Arg), tissue plasminogen activator(tPA), ceruloplasmin(Cer) and nitric oxide(NO) were studied in biochemical analysis. Results: Our results showed that Ki-67 proliferation index was low in Groups 1. The proliferation coefficient was significantly higher in the Group 2 and Group 4 than in the Group 1 and Group 3.(P < 0.001 between Groups 1 and 2, 1 and 4, and 3 and 4). There was no difference between Groups 2 and 4 (P = 1). The results of the biochemical Arg, tPA and Cer test showed statistically between the Group 1 and Group 2. NO showed significant differences Group 1 and 3. Conclusions: Thymoquinone and curcumin both have known positive effects on the organism. Histological and biochemical tests showed that thymoquinone is more effective than curcumin.

A swallowed dental prosthesis causing duodenal obstruction in a patient with schizophrenia: Description of a new technique.

INTRODUCTION: Foreign body ingestion has been a fundamental subject in the area of emergency surgery. The problem is encountered across all age groups; however, it is more common in the pediatric age group. Foreign body ingestion is rare in adults and usually occurs accidentally or in those with psychiatric problems, behavioral disorders, emotional disturbance, mental retardation, or impaired judgment caused by alcohol use. PRESENTATION OF CASE: A 33-year-old Caucasian man with chronic schizophrenia was admitted to the emergency department with signs of upper gastrointestinal discomfort as a result of ingestion of a lower dental prosthesis. An abdominal X-ray showed the swallowed dental prosthesis in front of the vertebral column. A technique comprising gastrotomy and duodenal kocherization was used to remove the dental prosthesis; the prosthesis could not be removed endoscopically due to its fixed position on the duodenal wall. DISCUSSION: Surgery of the duodenum is difficult and carries high mortality and morbidity. Therefore, endoscopy should be the first choice for patients in whom a foreign object is demonstrated to be fixed in the duodenum. In cases where endoscopic extraction fails, surgery should be considered. During surgery, foreign bodies should be removed, paying meticulous attention not to harm the integrity of the duodenum. CONCLUSION: The technique presented in this study was performed successfully without any injury to the duodenum.