Therapeutic Potential of Silymarin in Mitigating Paclitaxel-Induced Hepatotoxicity and Nephrotoxicity: Insights into Oxidative Stress, Inflammation, and Apoptosis in Rats.

Background: Paclitaxel (PAX) is a widely used chemotherapy drug for various cancer types but often induces significant toxicity in multiple organ systems. Silymarin (SIL), a natural flavonoid, has shown therapeutic potential due to its multiple benefits. Aims: To evaluate the therapeutic efficacy of SIL in mitigating liver and kidney damage induced by PAX in rats, focusing on oxidative stress, inflammation, and apoptosis pathways. Study Design: Experimental animal model. Methods: The study included 28 male Wistar rats aged 12-14 weeks weighing 270-300 g. The rats were divided into four groups: control, SIL, PAX, and PAX + SIL, with seven in each group. The rats received intraperitoneal (i.p.) injections at a dose of 2 mg per kilogram of body weight of PAX for 5 successive days, followed by oral gavage with 200 mg/kg body mass of SIL for 10 uninterrupted days. We examined the effect of SIL on specific serum biochemical parameters using an autoanalyzer and rat-specific kits. The spectrophotometric methods was used to investigate oxidative stress indicators in kidney and liver tissues. Aquaporin-2 (AQP-2), B-cell lymphoma-2 (Bcl-2), cysteine aspartate-specific protease-3 (caspase-3), interleukin-6 (IL-6), nuclear factor kappa B (NF-κB), and streptavidin-biotin staining were used to assess immunoreactivity in PAX-induced liver and kidney injury models. Results: SIL treatment significantly reduced serum levels of alanine aminotransferase, aspartate aminotransferase, creatinine, urea, and C-reactive protein, indicating its effectiveness in treating PAX-induced liver and kidney injury. SIL treatment significantly reduced oxidative stress by increasing essential antioxidant parameters, such as superoxide dismutase, catalase, glutathione peroxidase, and glutathione. It also reduced malondialdehyde levels in liver and kidney tissues of SIL-PAX groups (p < 0.05). SIL administration reduced NF-κB, caspase-3, and IL-6 expression while increasing Bcl-2 and AQP2 levels in liver and kidney tissues of rats treated with SIL and PAX (p < 0.05). Conclusion: Our findings indicate the potential of SIL to alleviate PAX-induced liver and kidney damage in rats by reducing oxidative stress, inflammation, and apoptotic processes.

A comprehensive study of Helicobacter pylori infection: molecular analysis, antibacterial susceptibility, and histopathological examination.

Helicobacter pylori is a pathogen associated with gastroduodenal diseases. This study aimed; (i) to investigate H. pylori presence by invasive tests in adult dyspeptic patients, (ii) to determine antibiotic susceptibility and genotypic characteristics of the H. pylori isolates, and (iii) to investigate the relationship between the H. pylori genotypes and the histopathological findings. In this cross-sectional study, gastric biopsy samples from 208 adult dyspeptic patients were used for culture, tissue Polymerase Chain Reaction (PCR), and histopathological analysis. Antibiotic susceptibility of the H. pylori isolates was analyzed by gradient method. Analysis of the virulence genes was performed by monoplex PCR. Genetic profiles (from A to H) were created based on the virulence genes presence. Enterobacterial Repetitive Intergenic Consensus-PCR (ERIC-PCR) was used for the genotyping of the H. pylori isolates. The mean age of the patients was 46 (± 15) years and 128 (61.5%) of them were female. H. pylori positivity was detected by culture, tissue PCR and histopathological examination in 59 (28.4%), 114 (54.8%) and 81 (38.9%) patients, respectively. The overall prevalence of H. pylori was found to be 63% (131/208). All H. pylori isolates were susceptible to tetracycline and amoxicillin. The resistance rates for metronidazole, clarithromycin, levofloxacin, and rifampicin were 67.2%, 27.9%, 34.4% and 13.11%, respectively. Multi drug resistance (MDR) was detected at the rate of 45.9% (28/61). While the most common virulence gene was cagA (93.44%), the least common was vacAm1 (23%). The predominant genetic profile was profile A (47.5%). ERIC-PCR results revealed a total of 26 different patterns. A high prevalence of H. pylori was detected in adult dyspeptic patients as in developing countries. It was observed significant genotypic heterogeneity and virulence gene diversity within the isolates. A considerable resistance rate detected against antibiotics such as clarithromycin, metronidazole, and levofloxacin, which are frequently used in the eradication of H. pylori, should be taken into consideration when creating regional empirical treatment regimens.

Clinicopathological Factors Affecting Mucin 1, Mucin 2, and Mucin 5AC Staining in Patients who Underwent Resection for Colorectal Cancer.

OBJECTIVE: To investigate the clinicopathological factors affecting mucins (MUC 1, MUC 2, and MUC 5AC) staining in patients who underwent resection for colorectal cancer. STUDY DESIGN: An observational study. Place and Duration of the Study: Department of General Surgery and Department of Pathology, Kafkas University Faculty of Medicine, Kars, Turkey, between January 2020 and January 2021. METHODOLOGY: Patients operated on for colorectal adenocarcinoma were included in the study. Patients who underwent colorectal surgery for benign diseases or had a pathological diagnosis other than adenocarcinoma were excluded from the study. Clinicopathological factors affecting MUC1, MUC2, and MUC5AC staining were evaluated with appropriate statistical tests, assuming a significant p-value of less than 0.05. RESULTS: Of the 30 patients who met all study criteria, 18 (60%) were males. The mean age of all patients was 62.83±16.79 (21-88). MUC1 strongly positive staining was observed in 18 (60%) cases, and high expression was detected in pT4 and pT3 cases (p=0.005). In addition, increased expression was also noted in cases with lymph node involvement (p=0.045). MUC2 expression was more than 60% (strongly positive) in 20 (66.7%). The MUC2 expression was increased in moderately differentiated cases (p=0.032). There was no staining (negativity) in 22 (73.3%) cases with MUC5AC, and more than 60% staining (strongly positive) was observed in 3 (10%) cases. In addition, strong expression was noted in rectosigmoid tumours (p=0.001), female patients (p=0.046), and patients with pT3 and pT4 tumours (p=0.05). CONCLUSION: High MUC1 and high MUC5AC staining were observed in advanced colorectal cancer, whereas high MUC2 staining was observed in patients with moderate tumour differentiation. KEY WORDS: Colorectal cancers, Gene expressions, Mucin.

Determination of Factors Affecting Human Transmission of Echinococcus granulosus Parasite: A Case-control Study, Turkey

Objective: Through this study we aimed to determine the risk factors affecting the transmission of Echinococcus granulosus to humans. Methods: This case-control study included a study group comprising of 107 people who underwent surgery for hydatid cyst and a control group comprising of 107 people. Place of living, age, and sex were taken as matching factors. A chi-square analysis was used for paired comparisons in the study. The variables that were significantly related in paired comparisons were included in the logistic regression analysis. Results: Hydatid cyst disease was seen 3.661 [confidence interval (CI) =1.650-8.123] times more often in individuals with an education period of 11 years or less compared to those with 12 years or above, 3.427 (CI=1.470-7.991) times more in those with a toilet outside the house compared to those with a toilet inside the house, and 5.540 (CI=2.088-14.697) times more in individuals who took a shower 8 times a month or less compared to those who take a shower 9 times or more. Conclusion: Individuals with a low level of education and who do not pay attention to environmental and personal hygiene are at risk for hydatid cyst disease.

DIFFERENT SURGICAL METHODS IN COLON ANASTOMOSIS: EXPERIMENTAL STUDY.

AIM: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

What Is the Effect of Inguinal Hernia Operations on Sexual Functions?

OBJECTIVE: The study aimed to evaluate sexual function before and after inguinal hernia surgery using a standard, internationally approved, patient-administered questionnaire. METHODS: 57 male inguinal hernia cases operated with the Lichtenstein hernioplasty technique were prospectively included in the study. Patients who agreed to participate in the study had the IIEF (International Index of Erectile Function) scoring system form consisting of 15 questions filled in preoperatively, during the first and sixth months after surgery. Patients' age, BMI, comorbidity, employment status, hernia type, hernia size, and single or bilateral hernia were recorded. The relationship between these variables was evaluated by statistical analysis. RESULTS: A statistically significant difference was found in terms of erectile function, sexual desire, intercourse function, and overall satisfaction, when the preop-postop first month, preop-postop sixth month, and postoperative first month-postop six-month scores were compared (p < 0.05). CONCLUSIONS: Pain and swelling due to an inguinal hernia can negatively affect the sexual functions of the patient, and most of the patients benefit from this after the surgery. Sexual dysfunction may be one of the indications for an inguinal hernia operation.

Factors Affecting the Choice of Treatment in Hepatic Hydatid Cyst Surgery.

OBJECTIVE: We aimed to determine the effective factors in the selection of treatment methods for patients with hepatic hydatid cyst undergoing surgery and the variables effective when performing postoperative endoscopic retrograde cholangiopancreatography (ERCP). In addition, we aimed to reveal the factors affecting the recurrence, postoperative complications, and length of stay of these patients. MATERIALS AND METHODS: A total of 107 patients diagnosed with hepatic hydatid cysts were treated surgically. Data were obtained from the records of these patients. Chi-square test was used for the analysis. The variables that were found to be significant in the chi-square analysis were included in the logistic regression (Backward: LR) analysis. RESULTS: Of all patients, 6.5% underwent the puncture, aspiration, injection, and reaspiration (PAIR) technique, 67.3% underwent conservative surgery, and 26.2% underwent radical surgical treatment. In paired comparisons, a significant difference was found among the ultrasonographic size of the cyst (p = 0.033), the radiological classification of the cyst (0.006), and history of previous surgery and treatment methods for the cyst. The risk of performing ERCP was 25.710 [95% confidence interval (CI): 1.721-284.013] folds higher for cysts located in the left lobe, whereas it was 19.992 (95% CI: 2.004-199.488) folds higher for cysts located in both right and left lobes. When the radical surgical treatment method was taken as a reference, the status of ERCP implementation was 29.785 (95% CI: 1.844-480.996) folds higher for PAIR and 3.628 (95% CI: 0.355-37.103) folds higher for conservative surgery. CONCLUSION: In conclusion, radical surgery is a significant treatment for hepatic hydatid cyst as its ultrasonographic cyst size increases with time. The location and treatment method of the cyst increases the complication of biliary fistula and requires ERCP.

Different surgical methods in colon anastomosis: experimental study / Diferentes métodos cirúrgicos em anastomose do cólon: estudo experimental

ABSTRACT - BACKGROUND: Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing. AIM: The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats. METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount. RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05). CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

RESUMO - RACIONAL: Embora muitos métodos tenham sido definidos para anastomose colônica, a fistula anastomótica ainda permanece importante para o controle da sepse e a cura bem-sucedida. OBJETIVO: comparar os efeitos da sutura convencional, tela de poliglactina 910 e cobertura de retalho omental na cicatrização e extravasamento anastomótico em anastomose colônica experimental em ratos. MÉTODO: estudo realizado em 18 ratos Wistar, sendo os animais divididos em 3 grupos. Grupo 1: Grupo de sutura primária; Grupo 2: sutura primária com malha de poliglactina 910; Grupo 3: Grupo sutura primária com cobertura de retalho omental. Os grupos foram comparados em termos de pressão de ruptura anastomótica, inflamação, atividade fibroblástica, neovascularização e quantidade de colágeno. RESULTADOS: houve diferença estatisticamente significativa na pressão de ruptura da anastomose entre os Grupos 1 e 2 e os Grupos 1 e 3 (p=0,004, p<0.05). Houve uma diferença significativa na atividade fibroblástica entre os Grupos 1 e 3 (p=0,011, p<0.05) e os Grupos 2 e 3 (p=0,030, p<0.05). Houve uma diferença significativa na neovascularização e colágeno entre os Grupos 1 e 2 e entre os Grupos 1 e 3 (p<0,05, p<0.05). CONCLUSÃO: o estudo experimental demonstrou que a tela de poliglactina 910 e a cobertura do retalho omental para anastomoses colocólicas melhoraram a resistência física e a cicatrização da anastomose em comparação com as anastomoses suturadas manualmente convencionais. A poliglactina pode ser uma alternativa segura à tela 910 nos casos em que a cobertura do retalho omental não pode ser utilizada na anastomose colônica.

[Helicobacter pylori Positivity and Risk Analysis in Patients with Abdominal Pain Complaints]. / Abdominal Agri Yakinmali Hastalarda Helicobacter pylori Pozitifligi ve Risk Analizi.

Helicobacters have wide host diversity due to the their particular virulence and environmental factors and may cause infections in humans. As they live in and around the stomach the group is called as gastric helicobacters which particularly consists of Helicobacter pylori and Helicobacter heilmanni, Helicobacter felis, Helicobacter salomonis and many other species, as well. In this study, it was aimed to evaluate 195 patients (119 urban and 76 rural residents, 121 female and 74 male individuals between 18 and 93 years of age) in terms of gastric Helicobacter (H.pylori, H.felis and H.heilmanii) who have admitted to the Health Research and Application Center of Kafkas University Endoscopy Unit of the General Surgery Department with the complaints of abdominal pain. For this purpose, biopsy specimens obtained from various parts of the stomach (corpus and antrum) by endoscopy were analyzed with histopathological examination and PCR. Histopathological analysis sections were stained with May-Grunwald-Giemsa and spiral-shaped helicobacters attached to the surface of the epithelium were investigated. For the direct analysis of Helicobacter in biopsy samples, 16S rRNA gene based genus-specific and urease B gene based species-specific PCR methods were used. Out of the 195 cases that were histopathologically evaluated 163 (83.58%) were found to be positive for gastric Helicobacter, while five were suspected and 27 were negative. Helicobacter spp. DNA were detected in 107 (54.87%) samples, of these samples 91 were histopathologically positive, 13 were negative and three were suspicious samples. Eighty seven (44.61%) of the samples were identified as H.pylori by species-specific PCR. H.felis and H.heilmannii could not be detected in any of the samples; meanwhile genus-specific PCR positive 20 samples were not identified. In this study, 42.85% of the individuals living in urban area and 47.36% of those living in rural area were identified as H.pylori positive. 46.28% of women and 41.89% of men were positive for H.pylori. The age range of H.pylori positive individuals were as follows: 60% of the individuals were between 15-24 years, 60.27% of the individuals were between 25-44 years, 34.66% of the individuals were between 45-64 years and 29.72% of the individuals were 65 and over. 42.64% of the cat or dog owners were found as H.pylori positive whereas H.pylori was positive in 45.66% of the individuals who do not own animals. No significant relationship was found between these determinants and the prevalence of the disease (p> 0.05). However, the positivity of H.pylori was higher in the 25-44 active working age group due to the increased agent exposure (p<0.05). This study is the first study on the prevalence of H.pylori in humans and analysis of possible risk factors in the region and hoped to provide useful information for the researchers working in this field.

Expression profile and cellular localizations of mucin proteins, CK7, and cytoplasmic p27 in Barrett's esophagus and esophageal adenocarcinoma.

PURPOSE: Barrett's esophagus is one of the main risk factors for increased incidence of esophageal adenocarcinoma. In this study, we studied protein expression levels and cellular localizations of MUC-1, MUC-2, MUC-5AC, CK7, and cytoplasmic p27 to assess the relationship between the expression of each of these proteins and the disease progression on endoscopic biopsies. MATERIALS AND METHODS: Immunohistochemical analyses were performed using antibodies produced against MUC-1, MUC-2, MUC-5AC, CK7, and p27. Endoscopic specimens of esophageal mucosa were obtained from 72 patients who underwent esophagectomy for Barrett's esophagus, metaplasia, dysplasia, or esophageal adenocarcinoma developed from Barrett's esophagus. RESULTS: Multilayer squamous epithelium showed only MUC-1 positivity in the EAC group while MUC-2 and MUC-5AC staining could not be detected in this group. Strong and diffused membranous or cytoplasmic staining of CK7 was observed at squamous, ductal, surface columnar and/or glandular epithelium. c-p27 staining was diffused and moderate in the cellular membranes observed in all groups except for esophageal epithelial metaplasia without intestinal metaplasia. Additionally, weakly focal cytoplasmic staining in squamous epithelium of p27 in EAC was detected. CONCLUSIONS: Barrett's esophagus, which has a heterogeneous epithelium, might yield different diagnosis based on endoscopic evaluation and immunohistological investigation. Thus, the use of MUC1, p27, and CK7 might strengthen the truthful diagnosis. MUC-1, CK7, and c-p27 immunostaining can be used as the predictive markers for esophageal cancer progression from Barrett's esophagus.

Acute biliary pancreatitis in cholecystectomised patients.

OBJECTIVE: The present study is an evaluation of cases of acute biliary pancreatitis that developed subsequent to cholecystectomy. METHODS: Total of 44 patients were assessed in this retrospective study. Demographic characteristics, severity of illness, time elapsed between cholecystectomy and development of pancreatitis, whether endoscopic sphincterotomy (ES) was performed, surgical procedure used, duration of hospitalization, and mortality data were recorded. RESULTS: Mean age of all patients was 60.14±16.4 years (range: 20-85 years), and female:male ratio was 28:16. Mean length of time elapsed between cholecystectomy and development of acute pancreatitis was 80.6 months (range: 5-230 months). Gallstones and biliary sand were found in the choledochi of 36 patients upon endoscopic retrograde cholangiopancreatography (ERCP), but not observed in the remaining 8 patients. ES was performed and material was extracted in 32 of the 36 patients, but stone extraction was unsuccessful in 4 cases; 3 patients underwent open surgery with choledochus exploration and 1 patient died. Excluding this patient, mean duration of hospitalization was 7.5±2.5 days. CONCLUSION: Stones in bile ducts may remain asymptomatic for long periods after cholecystectomy. However, some stones trigger acute pancreatitis months or years after cholecystectomy, causing risk of mortality. ERCP and ES are the standard treatments. If these are unsuccessful, the choledochus may be explored via open or laparoscopic surgery.

Neutrophil to Lymphocyte Ratio on Appendectomy of Geriatric and Nongeriatric Patients.

PURPOSE: Acute appendicitis is the most frequent emergency procedure that requires acute surgical intervention. The mortality risk is higher in geriatric patients. There is not a single parameter to diagnose it easily and negative appendectomy is traditionally accepted however the operation itself can cause morbidity and mortality especially in elderly patients. The neutrophil-to-lymphocyte ratio is a predictor of acute inflammation and was recently studied for the diagnosis of AA. The aim of this study is to analyze the diagnostic value of NLR on positive appendectomy rates amongst geriatric and nongeriatric patients. MATERIALS AND METHODS: 755 patients admitted to the emergency department, with abdominal pain who underwent urgent laparotomy after diagnosed as acute appendicitis. Patients' ages, genders, laboratory results, and intraoperative findings were collected. Geriatric patients were analyzed in group one, and nongeriatric patients were in group 2. Groups then sorted into subgroups by means of positive and negative appendectomies. RESULTS: Although NLR was higher in positive appendectomy subgroup in group 1 it was not statistically significant. NLR could not independently predict positive appendectomy in geriatric patients. In group 2, male gender was significantly higher in the positive appendectomy group (p < 0.001). NLR was also significantly higher in the positive appendectomy group (p < 0.001). In group 2 NLR could independently predict positive appendectomy (p < 0.001). CONCLUSION: NLR could not predict positive appendectomy rates in the geriatric population but could in the nongeriatric patient group. To find the optimal NLR levels, prospective randomized studies are needed.

Maternal and fetal outcomes after laparoscopic vs. Open appendectomy in pregnant women: data from two tertiary referral centers.

Objectives: Appendectomy is the most common cause of non-obstetric surgery in pregnant women. Our aim was to compare the clinical characteristics, peri-and post-operative data of pregnant women undergoing either laparoscopic appendectomy (LA) or open appendectomy (OA). Materials and methods: This was a retrospective study of medical records of all pregnant women diagnosed and treated surgically for acute appendicitis at two referral centers of Yuzuncu Yil University Medical Faculty and Kafkas University Medical Faculty, from January 2010 to January 2015. Results: The study included 48 patients, divided to two groups (12 - LA and 36 - OA). There were no significant differences in demographic characteristics of the studied population, including age, BMI, gestational age at operation, gravidity, parity, and history of cesarean sections. A far as obstetric and fetal outcomes are concerned, no significant differences were found in terms of preterm delivery, fetal loss, delivery mode, birth weight, APGAR score, and maternal death between the two investigated groups. One perioperative complication of intra-abdominal abscess was noted in the OA group. However, the LA group had shorter hospital stay (3.25±2.45 vs. 4.28±3.31, p=0.004), earlier mobilization time (8.1±2.2 vs. 10.1±1.6, p=0.025), and shorter time to first flatus (2.3±0.3 vs. 4.0±1.6, p=0.032) as compared to the OA group. The OA group had statistically shorter operation time than the LA group (38.61±11.5 vs. 49.42±11.38, p=0.007). Conclusion: LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

Single Port vs. Four Port Cholecystectomy--Randomized Trial on Quality of Life.

BACKGROUND: Classical laparoscopic cholecystectomy involves four ports while most novel 'single port' technique only requires one incision on the abdominal wall. This technique is thought to decrease surgical trauma and improve cosmesis although there are reports pointing out that classical laparoscopic cholecystectomy is also feasible in terms of cosmesis. OBJECTIVES: In this study we tried to determine if there are certain advantages in quality of life after single port surgery which would justify its utilization instead of classical laparoscopic cholecystectomy. MATERIAL AND METHODS: This is a prospective randomized study which enrolled 30 patients randomized either into classical laparoscopic cholecystectomy or single port surgery. The primary endpoint was patient satisfaction after surgery. This was assessed with short form 36 and gastrointestinal quality of life index (first preoperatively and then 3 months postoperatively) and a visual analogue scale on the first and seventh days. RESULTS: There was not a statistically significant difference between groups in the emotional role, social functions, mental health, vitality and general health subscales of short form 36. At the end of 12 weeks, both groups demonstrated increases in the gastrointestinal and social subscales of the gastrointestinal quality of life index. There was not a statistically significant difference between groups when the visual analogue scale scores on first and seventh days were compared. CONCLUSIONS: The equal length of hospitalization, patient quality of life and pain perception and the longer operative times, high likelihood of incisional hernia and surgical site infection call into question the utilization of single port surgery, as it does not seem to confer an advantage over classical laparoscopic cholecystectomy.

The Situation of Cystic Echinococcoses in Kars State Hospital for The Last Five Years.

OBJECTIVE: This study was conducted to contribute to the information regarding the spread of cystic echinococcosis (CE) in our country and to reveal its importance in our region by determining the spread of CE in people. METHODS: CE cases, which were detected by retrospectively reviewing the records at Kars State Hospital in Kars between 2009 and 2013, were evaluated in terms of age group, gender, and organ involvement. For features, descriptive statistics were stated in numbers and percentages. RESULTS: According to the obtained results, in total, 168 CE cases were specified. While female patients constitute 101 cases (60.1%), male patients constitute the remaining (39.9%). Their distribution was specified between the ages of 3 and 79 years, and it was ascertained that the cases were mostly between the age groups of 16 and 30 years at the rate of 26.8%. The second most frequent age group was between 31 and 45 years at the rate of 25.6%. CE was mostly seen in the lung (49.4%) and liver (44.6%). Additionally, 10 patients with CE in both the lung and liver were ascertained. CONCLUSION: It is seen that CE is an important public health problem in Kars. Extensive protection and control programs should be implemented against this disease.

Large bowel injuries during gynecological laparoscopy.

Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture.

OBJECTIVE: Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. MATERIAL AND METHODS: Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. RESULTS: The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. CONCLUSION: MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.