Surgical approach to extensive hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic suppurative disease of skin with high recurrence. OBJECTIVE: To determine factors affecting complications and recurrence of HS in patients who underwent surgery. MATERIALS AND METHODS: We operated on 15 patients with HS at 36 sites between 1999 and 2009. The affected areas were classified as groin, axilla, buttocks, nuchae, perianal, and perineal. All patients were treated using wide surgical excision under general anesthesia. The methods of reconstruction varied depending on the size and location of the defect. RESULTS: The female:male ratio of patients was 4:11. Mean age was 41.8 ± 10.6. Twenty-eight (77%) of the lesions were Stage III according to Hurley's staging system. Mean follow-up was 42 months. Radical excision was performed on all lesions; 20 were reconstructed with primary closure, nine with fasciocutaneous flaps, and five with split-thickness skin grafts. The overall complication rate was 25% (9/36) and complications occurred mostly in perineal, perianal, and buttocks sites. Two (5.5%) recurrences were seen only in buttocks site. CONCLUSION: To prevent complication, avoid recurrence of HS, and improve patients' quality of life, early and wide surgical excision is important and effective. The recurrence and complications are mostly related to the location of the disease. The authors have indicated no significant interest with commercial supporters.

[Effects of beta-glucan on hepatic damage caused by obstructive jaundice]. / Tikanma sariliginda beta glukanin karaciger hasarina etkisi.

BACKGROUND: Beta-glucans are known as macrophage stimulators and antioxidants. This study aimed to investigate the effects of beta-glucans on oxidative damage to the liver during obstructive jaundice. METHODS: Sham, control and treatment groups (7 Wistar Albino rats in each) were designed. In the treatment group, beta-glucan was given through gavages for 10 days after bile duct ligation. All groups were sacrificed on the 11th day. Liver function tests, superoxide dismutase (SOD), myeloperoxidase (MPO), malondialdehyde (MDA), lipid peroxide (LPO), glutathione (GSH), and histopathological examination of the liver were investigated. RESULTS: In the treatment group, the levels of alanine and aspartate aminotransferases (AST, ALT), gamma glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total and direct bilirubin, MPO in the serum, and the levels of MDA and LPO in the liver tissue were significantly lower when compared with the control group. Moreover, SOD and GSH levels were relevantly high in the treatment group. Histopathological examination of the liver revealed less damage in the treatment group. CONCLUSION: These results show that beta-glucan induced the phagocytic and anti-oxidative effects and also reduced the liver damage and oxidative stress in obstructive jaundice. Advanced studies are required for the clinical use of beta-glucan in obstructive jaundice.

Oxidative stress and lipid peroxidation products: effect of pinealectomy or exogenous melatonin injections on biomarkers of tissue damage during acute pancreatitis.

BACKGROUND: Melatonin (N-acetyl-5-methoxytripta-mine) is a free radical scavenger and a strong antioxidant, secreted by the pineal gland. In this study, we evaluated the effects of decreasing and increasing serum melatonin levels on malonyldialdehyde (MDA), superoxide dismutase (SOD), and reduced glutathione (GSH) levels in pancreatic tissue from rats with experimental acute pancreatitis. METHODS: Experimental acute pancreatitis was induced in three groups of Wistar albino rats (10 animals per group) by pancreatic ductal ligation. The first group had only acute pancreatitis and served as the control. Surgical pinealectomy was added to acute pancreatitis in the second group, removing the source of endogenous melatonin (low melatonin levels group). The third group was given 0.1 ml daily intraperitoneal injections of 20 mg/ml melatonin solution for one week (high melatonin levels group). The effects of melatonin levels were evaluated by comparison of the levels of MDA, SOD, and GS in pancreatic tissue. RESULT: We found that intraperitoneal melatonin injections decreased the levels of MDA and increased the levels of SOD and GSH in pancreatic tissue. CONCLUSION: Exogenous melatonin has a preventive effect on lipid peroxidation and oxidative damage in acute pancreatitis.

A life-threatening multilocalized hidradenitis suppurativa case.

The patient was a 38-year-old man. He had been suffering from hidradenitis suppurativa (HS) for approximately 20 years. He had active lesions at both axillas, hip, scrotum, and perineum, and inactive lesions located behind the ears, lower abdomen, and posterior neck. He was monitored and treated at different branches; he continuously used antibiotics and was given steroids at times. Antibiotic resistance developed subsequently. His general situation was bad; vital signs were poor; and he was in a state of sepsis and preshock, so this case was regarded as life-threatening. Total excision was performed first on the lesion at the right axilla, then on the lesion at the left axilla, and the parascapular fasciocutaneous flap was reversed. A skin graft was applied to the triangular defect on the scapula. No relapse occurred. Then the lesions at the hip were managed. Broad excision was used twice with the patient under general anesthesia; because the lesions spread to the retrococcygeal and gluteal muscles, coccyx resection and partial gluteal muscle resection were implemented. The defect was eliminated with a progressive flap. At the intergluteal sulcus, small lesions emerging at the median line were debrided with the patient under local anesthesia, and together with secondary recovery, the disease was completely managed. Lesions at the perineum and scrotum and at both inguinal areas were broadly excised and grafted. No lesion has relapsed so far. One year later, Hodgkin's lymphoma was diagnosed, and the patient was treated with chemoradiotherapy easily, because there was no infective focus. The disease is in remission now. The patient weighs 110 kg, is healthy, and is working again.

A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia.

INTRODUCTION: There is no valid and reliable diagnostic test for early diagnosis of acute mesenteric ischemia (AMI). The aim of this study was to measure the plasma levels of diamine oxidase (DAO) and citrulline in AMI to gain insight into its early diagnosis. MATERIAL AND METHODS: A total of 21 Wistar albino rats were divided into three groups, that is, control group, short-term ischemia group, and prolonged ischemia group. The superior mesenteric artery was occluded for 15 min in the short-term ischemia group and for 12 h in the prolonged ischemia group. Twelve hours later, the experiment was terminated and plasma DAO and citrulline levels were measured. Intestinal tissue was evaluated for the histopathological changes. RESULTS: Compared to the control group, the short-term and prolonged ischemia groups showed significant increases in the plasma levels of DAO, whereas the plasma citrulline levels decreased significantly. Prolonged ischemia caused a larger increase in the plasma DAO levels and a larger decrease in the plasma citrulline levels compared to the short-term ischemia (p=0.011 and p=0.021, respectively). Intestinal damage was shown to develop more in the prolonged ischemia group (p=0.001). CONCLUSION: In the early period of AMI, the plasma DAO levels increase while citrulline levels decrease, and the extent of these changes depends on the duration of ischemia.

Effect of beta-glucan in lung damage secondary to experimental obstructive jaundice.

BACKGROUND/AIMS: This study aimed at investigating the protective effects of beta-glucans on the lungs in obstructive jaundice. METHODS: In total, five groups -Sham (1), control (2) and treatment groups (3,4,5)- were established; each comprising randomly selected seven Wistar Albino rats. Beta-glucan was given after choleduct ligation in Group 3 while it was given before and after the choleduct ligation in Group 4. As pre-treatment beta-glucan was given before ligation in Group 5. Beta-glucan was administered in a single dose of 50 mg/kg/day by gavage for a ten-day period. Superoxide dismutase, and myeloperoxidase levels in serum; malondialdehyde, lipid hydroxyperoxidase and glutathione levels in lung tissue; lactate dehydrogenase levels in bronchoalveolar lavage fluid were measured. RESULTS: The blood polymorphonuclear leukocytes level was highest in the control group and lower in the sham and treatment groups. Serum superoxide dismutase and tissue glutathione values were significantly higher in Groups 3 and 4 (p≤0.04) whilst Groups 3 and 4 did not differ from each other. In Groups 3 and 4 malondialdehyde, lipid hydroxyperoxidase, and myeloperoxidase values were significantly lower. However, Groups 3 and 4 did not differ for malondialdehyde or lipid hydroxyperoxidase values. Lactate dehydrogenase level in the bronchoalveolar lavage fluid was significantly lower in all of the treatment groups (Groups 3,4,5) (p≤0.008). When compared to the control group, it was observed that lung damage was much more limited in the treatment groups (p<0.001). CONCLUSION: This study suggests that beta-glucan exhibits protective effect in pulmonary tissue against oxidative damage in obstructive jaundice.

The association between thyroid malignancy and chronic lymphocytic thyroiditis: should it alter the surgical approach?

BACKGROUND: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. MATERIAL AND METHODS: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto's thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. RESULTS: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto's thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). CONCLUSIONS: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability.

Evaluation of the effects of melatonin administration intraperitoneally on rats with acute pancreatitis induced by ductal ligation.

BACKGROUND/AIMS: The aim of this study was to address the protective effects of exogenous melatonin injections intraperitoneally on the histopathological changes in a model of obstructive acute pancreatitis. METHODS: In this study, ductal ligation technique was used in 20 adult male Wistar Albino rats to develop a model of obstructive acute pancreatitis and beginning pancreatic atrophy. Melatonin 20 mg/kg solution was injected in one group of rats intraperitoneally for one week and results were compared with the control group regarding histopathological findings in the pancreatic tissue. RESULTS: The apoptosis rate in control group rats was 30.5%, while it was 12.7% in the melatonin group. Pancreatic edema, hemorrhage and polymorphonuclear leukocyte infiltration decreased remarkably in the melatonin group compared to the control group. CONCLUSIONS: Injection of exogenous melatonin in rats with obstructive acute pancreatitis for seven days prevents acinar cell degeneration, apoptosis and polymorphonuclear leukocyte infiltration.

Exogenous melatonin treatment reduces hepatocyte damage in rats with experimental acute pancreatitis.

BACKGROUND/PURPOSE: The hormone melatonin affects cellular immunity in particular and the immune system in general both directly and indirectly. We report our evaluation of the effects of decreasing and increasing serum melatonin levels on hepatocyte damage in rats with experimental acute pancreatitis. METHODS: Wistar Albino rats with experimentally induced acute pancreatitis were divided into three groups of ten rats each: (1) control (induced acute pancreatitis only); (2) rats with induced acute pancreatitis plus surgical pinealectomy (no melatonin injections); (3) rats with induced acute pancreatitis plus injections of exogenous melatonin. The effects of melatonin levels were evaluated using biochemical and histopathological parameters. RESULTS: Rats undergoing the pinealectomy had increased amylase and lactate dehydrogenase (LDH) levels, while those receiving injections of exogenous melatonin had decreased amylase, aspartate transaminase, LDH, and bilirubin levels but increased levels of alanine transferase levels. CONCLUSION: Melatonin may have a therapeutic or protective effect on acute pancreatitis and obstructive jaundice.

Second primary cancers in patients with gastric cancer.

BACKGROUND: The risk of developing a second primary tumour in patients with gastric carcinoma is higher than among the general population. The aim was to investigate the clinicopathological characteristics of the second primary cancers in patients with gastric cancer in this study. PATIENTS AND METHODS: In the retrospective study, patients with gastric cancers were evaluated between 1995 and 2005 for primary tumours according to Warren and Gates' criteria related with the second primary cancers. RESULTS: Nine of the 112 patients with gastric cancer had second primary cancers. Seven of the patients were males and two females. Six patients with gastric cancers had synchronous, and three had metachronous tumours. The age of the patients ranged from 53 to 78 years, and the mean age was 61 ± 8.3 years. The most frequent site of occurrence of the second tumours was the colo-rectum (33%) followed by the upper respiratory system (22%), and the urogenital system (22%) in descending order of frequency. CONCLUSIONS: The incidence of the second primary cancer in gastric cancer patients was 8% in the current report. It is recommended that careful preoperative and postoperative examinations for other primary cancers, as well as for the extent of the primary gastric carcinoma, are carried out. Because colorectal cancer was the most common carcinoma combined with gastric carcinoma, the surveillance for this carcinoma (e.g., colonoscopy, abdominopelvic CT) would be appropriate after the diagnosis of gastric carcinoma.

The clinical characteristics of female patients with Fournier's gangrene.

INTRODUCTION AND HYPOTHESIS: Our aim was to review our experience with Fournier's gangrene in female patients. METHODS: A retrospective review of ten consecutive female patients with Fournier's gangrene was performed. Etiological and predisposing factors, causative microbiological organisms, and clinical outcome were investigated. RESULTS: Mean age of the patients was 52.7 years, and the mean duration of hospitalization was 17.6 days. The etiologic origin of the gangrene was anorectal, dermatological, and urogenital infection in 50%, 20%, and 10% of patients, respectively. All patients underwent aggressive surgical debridement and a diverting colostomy. Nine patients survived, and one patient died for an overall mortality rate of 10%. CONCLUSIONS: Fournier's gangrene occurred in females with a pattern similar to that in males. We believe that a colostomy is an integral part of management for patients requiring extensive debridement, especially if the infection arises in the anorectal region.