Contribution of an educational video to surgical education in laparoscopic appendectomy.

OBJECTIVE: With recent widespread advances in laparoscopy, providing education on this subject has become a significant challenge. The aim of this study was to determine the degree of contribution made by surgeons to laparoscopic education through an educational video. MATERIAL AND METHODS: A total of 40 volunteer general surgery residents and specialists participated in our study. Before watching the approximately six-minute educational video prepared for laparoscopic appendectomy, the participants were asked to fill out participant information forms and information measurement questionnaire forms. After the video, the participants were asked to fill out the information measurement questionnaire forms a second time; additionally, attitude evaluation forms and education evaluation questionnaire forms were presented to the participants for completion, and statistical analysis was performed. Furthermore, the total watching duration and the number of times the video was paused were recorded. RESULTS: A total of 40 surgeons participated in the study (75% residents and 25% specialists). When the results of the information determination questionnaire forms filled out by the resident and specialist groups before and after the video were compared, it was observed that the scores of both groups significantly increased after watching the video (p=0.001). A statistical significance was identified between the length of time the video was watched and the education evaluation form scores of the participants (p<0.01). It was observed that the longer the video was watched, the greater the increase in the education evaluation scores. The results of the attitude evaluation forms implied that the video could be produced more professionally. CONCLUSION: Although education is an inevitable requirement of laparoscopic surgery, many teaching methods are available. Awareness-enhancing videos prepared on this topic can be efficient in providing laparoscopic education.

Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies.

BACKGROUND: One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. METHODS: A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. RESULTS: The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. CONCLUSION: TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.

Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer.

OBJECTIVE: Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed. MATERIALS AND METHODS: One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated. RESULTS: Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p<0.05) between the other risk factors, which were axillary dissection (AD), number of positive lymph nodes (LN), radiotherapy (RT), the tumor size (T), and lymphedema existence. In every case in which lymphedema was determined, it was seen that there was axillary LN involvement and 15≤LN were ablated in the dissection (p<0.05). CONCLUSION: It is seen that AD, RT applied to the breast cancer patients, and T are important risk factors in early-stage lymphedema development. No early-stage lymphedema development was determined in any of the patients to whom sentinel lymph node dissection (SLND) was applied.

Hyaluronic acid/carboxymethylcellulose membrane barrier versus taurolidine for the prevention of adhesions to polypropylene mesh.

BACKGROUND: A hyaluronic acid/carboxymethylcellulose (HA/CMC) membrane is an effective measure to prevent polypropylene mesh induced adhesions. We hypothesized that taurolidine 2% solution might be a cost-effective alternative to decrease adhesion formation. MATERIALS AND METHODS: Twenty-four rats were randomized into three groups: mesh alone (group 1), mesh + taurolidine 2% (group 2), and mesh + HA/CMC (group 3). Polypropylene mesh (4 cm2) was used to repair surgically induced anterior abdominal wall defects. Taurolidine 2%or a HA/CMC membrane was used as an antiadhesive measure. The animals were sacrificed 6 weeks after the operation, and adhesions to the prosthetic material were evaluated with digital image analysis. RESULTS: Group 1 (mesh alone) had the highest adhesion ratio (58.5 +/- 4.8%) compared with groups 2 and 3 (p < 0.05). The differences between groups 2 (mesh + taurolidine 2%; adhesion ratio 42.9 +/- 1.6%) and 3 (mesh + HA/CMC; adhesion ratio 40.3 +/- 3.0%) were not significant (p > 0.05). CONCLUSIONS: The animals of both treatment groups (2 and 3) had lower adhesion ratios compared with the controls (group 1). In particular, the HA/CMC membrane did not present with a superior antiadhesive effect compared with taurolidine. Therefore, taurolidine is a cost-effective alternative to HA/CMC membranes when a polypropylene mesh is used in direct contact with the abdominal viscera.

Brown tumors mimicking bone metastases.

Brown tumors are rare skeletal manifestations of hyperparathyroidism (HPT) that may mimic cancer metastasis. Here, we present a 52-year-old woman with HPT and multiple foci of technetium uptake due to brown tumors on bone scintigraphy. Screening tests were negative for cancer and serum parathormon (PTH) measurement; parathyroid ultrasonography and scintigraphy suggested HPT. A chief cell adenoma in right and hyperplasia in the left parathyroid glands were surgically removed after which hungry bone syndrome emerged. Biopsy of the femur lesion during an open reduction with fixation operation due to a fracture established the diagnosis of a brown tumor. Brown tumors are important to consider in the evaluation of patients presenting with multiple foci of uptake on bone scanning and without an established primary neoplasm.

Effect of perioperative feeding with fibre & arginine on morphometrics of ileum after surgical stress.

BACKGROUND & OBJECTIVE: Major surgeries as well as other types of injury have been shown to affect the gut function. Enteral diets influence intestinal mucosal morphometry to different extents depending on their composition. Little is known about the effects of these defined-formula diets in patients with surgical stress but no malnutrition. This experimental study was undertaken to compare the effects of different enteral diets on the mucosal morphometrics of small bowel in surgically stressed rats without malnutrition METHODS: Male Wistar-Albino rats (n=84) weighing between 160-220 g were randomised into three groups. Group A received standard rat chow. Group B received a complete balanced nutrition supplemented with fibre, and the rats in Group C were given an isocaloric specialized elemental nutrition enriched with specific combination of nutrients and arginine. The feeding was started two days before the operation and continued until re-operation. Laparotomy, ileal transection, and end-to-end anastomosis was performed as the surgical procedure. The rats were sacrificed on days 0, 2 and 7 post-operatively. One cm of ileal segment containing the anastomosis was examined histologically. Parameters for intestinal mucosal morphometry (number of villi, villous height, mucosal thickness) and number of mucous containing cells were determined. RESULTS: Number of mucous cells per villus was significantly (P<0.05) higher in group A compared to groups B and C on days 0 and 2 post-operation. On day 7 villous height and mucosal thickness were also significantly higher in group A compared to the other two groups. INTERPRETATION & CONCLUSION: Laparotomy and a minor surgical intervention such as small bowel transection was not a major surgical stress for intestinal mucosal atrophy in rats without malnutrition. The effect of fibre and arginine enriched defined-formula diets did not seem to improve intestinal mucosal changes in such a surgical stress model compared with normal rat chow.

C-reactive protein may be a marker of bacterial translocation in experimental intestinal obstruction.

BACKGROUND: C-reactive protein (CRP) is used as a marker of intestinal ischaemia. This study evaluated whether CRP levels can be used to detect ischaemia-induced (strangulated) intestinal obstruction and subsequent bacterial translocation. METHODS: Forty-eight rats, divided into four groups underwent the following procedures: anaesthesia alone (native controls), laparotomy (sham-operated controls), or surgical induction of simple or strangulated intestinal obstruction (simple and strangulated obstruction groups, respectively). Blood samples were collected for culture and serum CRP analysis. In addition, liver and mesenteric lymph node (MLN) specimens were collected for culture, to determine the presence of bacterial translocation; and ileal segments, for histopathological investigation. RESULTS: CRP levels and rates of bacterial translocation, expressed as colony forming units (cfu) per gram wet tissue, were higher in both intestinal obstruction groups than in the native and sham-operated control groups (P < 0.001 for both). The increases in CRP levels paralleled increases in the number of cfu in the MLN and liver cultures (P < 0.01). Compared to controls, animals in the obstruction groups also had a higher incidence of positive blood cultures (P < 0.005) and greater histopathologic evidence of inflammatory infiltration of the lamina propria (P < 0.01). However, no significant difference between the simple and strangulated obstruction groups was observed. CONCLUSION: CRP levels increase with the severity of bacterial translocation in acute intestinal obstruction but do not permit discrimination between simple and strangulated intestinal obstruction.

Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing.

BACKGROUND: Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model. METHODS: Thirty-six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared. RESULTS: Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P=0.0003). Mean tissue hydroxyproline concentrations showed no difference (P>0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P=0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P=0.0009). CONCLUSION: Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.

Multiple melanotic schwannoma.

Melanotic schwannoma is a rare pigmented neural tumor most commonly occurring in the paraspinal region. In a small minority of instances, melanotic schwannoma may have multiple nodules. Here, a 52-year-old woman is presented with multiple melanotic schwannomas of paraspinal region.

Nitric oxide regulates bacterial translocation in experimental acute edematous pancreatitis.

BACKGROUND/AIMS: The role of nitric oxide (NO) in bacterial translocation (BT) associated with acute pancreatitis is controversial. We investigated the effects of the NO synthase substrate, L-arginine, and the NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), on BT in caerulein-induced acute pancreatitis in rats. METHODS: Acute pancreatitis was induced by subcutaneous injections of caerulein (12 microg/kg) at 6-hour intervals for 2 days. Subcutaneous injections of L-arginine (100 mg/kg) or L-NAME (10 mg/kg) were administeredonce daily for 2 days. At 48 h, pancreatic injury and BT to the mesenteric lymph nodes (MLN), liver, and peritoneum were assessed. RESULTS: Compared with controls, rats that received caerulein injections alone had increased BT to the MLN and pancreatic inflammatory changes. L-Arginine significantly reduced the inflammation and BT caused by caerulein. L-NAME did not significantly alter pancreatic inflammation. Although caerulein + L-NAME-treated rats had increased BT to the peritoneum, MLN, and liver compared with controls, rates of BT did not significantly differ between caerulein alone- and caerulein + L-NAME-treated rats. CONCLUSION: In acute edematous pancreatitis, BT is increased and is regulated by NO. NO substrates limit BT and pancreatic inflammation associated with acute pancreatitis, probably by their bactericidal actions and ability to improve pancreatic blood flow.