Tissue oxidative stress level and remote organ injury in two-hit trauma model of sequential burn injury and peritoneal sepsis are attenuated with N-acetylcysteine treatment in rats.

BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple organ failure. Infection following burn injury is a useful model for two-hit trauma studies. The aim of this study was to investigate the effect of N-acetylcysteine (NAC) treatment as an antioxidant in a two-hit trauma model. METHODS: 30% scalding burn injury was performed in 45 rats and cecal ligation-puncture (CLP) was performed 72 hours later. Groups were allocated as follows: Group I: No treatment was performed; Group II: Rats were treated with 150 mg/kg/day i.p. NAC for 72 h following CLP; Group III: Rats were treated with 150 mg/kg/day i.p. NAC for 6 days following thermal injury. Tissue samples were collected to study the tissue malonyldialdehyde (MDA) and glutathione (GSH) levels, and for histopathological examination on day 7. RESULTS: No difference in mortality between groups was detected. Tissue MDA levels significantly decreased in the liver (p=0.01, p=0.02) and ileum (p=0.01, p=0.02) in the treatment groups. Lung tissue GSH levels were found to be significantly increased in Group II (p=0.02). Lung injury scores were decreased in Group II (p=0.005) compared to the control group. CONCLUSION: NAC attenuated tissue oxidative stress level and remote organ injury in two-hit trauma. Further experimental and clinical studies on this subject are necessary.

Preoperative and postoperative evaluation of thyroid disease in patients undergoing surgical treatment of primary hyperparathyroidism.

OBJECTIVE: To evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS: In this case series, records of all patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2005 and December 2008 in our clinic were analyzed retrospectively. Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy; when needed, thyroid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used. All patients underwent standard neck exploration. Postoperative histopathologic findings of thyroid tissue were classified as nodular/multinodular hyperplasia, Hashimoto thyroiditis, papillary thyroid carcinoma, or normal. RESULTS: Fifty-one women and 9 men were included. In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroiditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%). Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77%. Total thyroidectomy was performed in 27 patients, and hemithyroidectomy was performed in 15 patients. Indications for total thyroidectomy were nondiagnostic or suspicious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients. Postoperatively, thyroid carcinoma was diagnosed in 9 patients (15%). CONCLUSIONS: Thyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism. This association should be considered when selecting the surgical procedure. Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism.

Ultrasonographic evaluation of thyroid nodules: comparison of ultrasonographic, cytological, and histopathological findings.

Thyroid ultrasonography (US) and fine needle aspiration biopsy (FNAB) are the most important tools in evaluating thyroid nodules. A total of 3,404 nodules in 2,082 cases referred to our clinic between 2005 and 2008 were analyzed retrospectively. Considering US features of nodules, risk factors predicting malignancy were: margin irregularity as the most important predictor, hypoechoic pattern and microcalcification (Odds ratios: 63.2, 13.3, 7.03, respectively). Cytologic results of the patients were as follows: 1,718 (82.5%) benign, 196 (9.4%) suspicious, 68 (3.3%) nondiagnostic, and 100 (4.8%) malignant. In histopathologic examination, we determined a malignancy rate of 7.59% (158/2082). We calculated the sensitivity of FNAB as 89.16%, specificity as 98.77%, positive predictive value as 96.10%, negative predictive value as 96.39%, and accuracy as 96.32%. In cytologic examination, the malignancy rate of subcentimetric (≤1 cm) nodules was higher than supracentimetric (>1 cm) nodules (5.1% vs. 1.5%, P = 0.001). In postoperative histopathologic examination, although the malignancy rate of subcentimetric nodules was higher than that of supracentimetric nodules, the difference was statistically insignificant (5.5%, 4.4%, respectively; P > 0.05). Cytologically diagnosed malignancy was detected in 4.5% of patients with multiple nodules, while it was present in 6% of patients with solitary nodule indicating no significant difference. However, postoperative histopathologic examination revealed a significantly higher malignancy rate in patients with solitary nodule compared to in patients with multiple nodules (11.7%, 6.5%; respectively, P < 0.001). The malignancy rate of patients operated for suspicious cytology was found to be 46.15%; for nondiagnostic cytology, it was 64.29%. In conclusion, ultrasonographically, hypoechoic pattern, microcalcification and margin irregularity of thyroid nodules are important features in determining the malignancy risk. The nodule size alone still remains inadequate to exclude malignancy risk.

A novel material in seton treatment of fistula-in-ano.

Fistula-in-ano is a common surgical problem. Various materials have been used to perform the seton technique in the treatment of fistula-in-ano. In this study, a novel material, a self-locking cable tie, was used regardless of the fistula type. Seventeen consecutive patients with anal fistula underwent surgery with the cutting seton technique using the novel material. Nine patients had high fistulas. The average tightening was 3.18, the mean fall-out time was 17.41 days, and the mean follow-up period was 8.2 months. No recurrences or incontinence were recorded. There are statistically significant differences between superficial and high fistula cases regarding the number of setons tightening, seton fall-out time, and complete healing time. The novel material presented here has some advantages: it is cheap, easily available, and easily applied, moreover, a gradual tightening can be performed. We think this novel material is a good choice in the treatment of fistula-in-ano.

Should the thyroid bed be drained after thyroidectomy?

BACKGROUND: Although routine drainage of the thyroidectomy bed is not an evidenced-based practice, most surgeons still employ routine drainage with an effort to monitor postoperative bleeding. The aim of this study is present our experience on draining and not draining the thyroidectomy bed. MATERIALS AND METHODS: Records of 1,066 patients who underwent thyroid surgery were evaluated retrospectively. RESULTS: The rates of the re-operations due to life-threatening postoperative hemorrhage and wound infections were higher in the drained group. The average postoperative hospital stay of the drained group was significantly longer than that of the non-drained group. CONCLUSION: Routine drainage of the thyroidectomy bed is not effective in decreasing the rate of postoperative complications after thyroid surgery, and it causes a prolonged hospital stay and surgical site infection.

Salmonella typhi abscess as a late complication of simple cyst of the liver: a case report.

Liver abscesses due to Salmonella species occur rarely. In this case report, we present a simple liver cyst as a focus for Salmonella abscess, which to date has never been described in the literature. This case report emphasizes that simple liver cyst could be infected with Salmonella and progress to a complicated liver abscess, which responds well to percutaneous catheter drainage and anti-biotherapy.

Thrombolysis via an operatively placed mesenteric catheter for portal and superior mesenteric vein thrombosis: report of a case.

Mesenteric venous thrombosis (MVT) is a catastrophic form of mesenteric vascular occlusion. In the absence of peritoneal signs, anticoagulation therapy should be started immediately. For selected patients, thrombolysis through the superior mesenteric artery (SMA), jugular vein, or portal vein via a transhepatic route might be successful; however, exploratory laparotomy is mandatory when peritoneal signs develop. We report a case of acute MVT associated with protein C and S deficiency, treated successfully by limited bowel resection and simultaneous thrombolytic infusion, given via an operatively placed mesenteric vein catheter.

Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial.

PURPOSE: Different surgical techniques for pilonidal disease have been described in the literature. In this study our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique. METHODS: Fifty patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively. The patients were assigned randomly into two groups-with and without suction drainage of the cavity-and the effects of drains were studied in terms of wound complications, hospital stay, and recurrence rate. RESULTS: There was no significant difference between groups in term of length of hospital stay. Complication rate was 20 percent and the complications were caused exclusively by fluid collections. Wound infection, dehiscence, or failure was not observed in any of the patients. There has been no recurrence in any of the patients during the follow-up period. There was a significant increase in the number of fluid collections in patents without a suction drain. CONCLUSION: The present study indicates that routine cavity drainage reduces the incidence of fluid collection after the Karydakis flap operation.

[Determination of malondialdehyde level in peritoneal fluid in patients with acute abdomen]. / Akut batinlarda peritoneal sivida malondialdehit (MDA) düzeyi ölçümü.

BACKGROUND: Our aim is to determine the relationship between free oxygen radicals and tissue destruction in Acute abdomen patients. METHODS: In this study, direct determination of free oxygen radicals is succeeded by measuring the Malondialdehyde level (MDA), which is the last product of lipid peroxidation in the peritoneal fluid of acute abdomen patients. Forty patients are included in the study of whom thirty patients were the study group and ten were taken as the control group. MDA levels of both groups and the differences between daily MDA levels of each group are compared statistically by using one way ANOVA, student t test and student Newman Keuls test respectively. RESULTS: There was statistical significant difference between study and control group (p < 0.05). Also there was significant difference between MDA levels of infected, non-infected and control groups (p < 0.01). It was understood that high MDA levels in the study group source from infected group and there was no significant difference between non-infected and control group. CONCLUSIONS: In this study we proved the high MDA levels in the peritoneal fluid of Infected Acute Abdomen patients. This result is meaningful for the diagnose and following of these patients.