Investigation of temporal illicit drugs, alcohol and tobacco trends in Istanbul city: Wastewater analysis of 14 treatment plants.

Wastewater-based drug monitoring is a complementary tool that has been used worldwide in recent years, and many cities have periodically reported monitoring results. However, this study is the first to analyze drugs in wastewater in a single city with a high population during four periods simultaneously from 14 treatment plants. The aim was to estimate the consumption of conventional illicit drugs [amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, cocaine, and heroin], tobacco, and alcohol in 2019 for quarterly periods in Istanbul city, which has a population of almost 20 million, to aid in implementing evidence-based measures. Additionally, the seasonal variations among the 14 wastewater treatment plants and their weekday/weekend comparison of drug use patterns and consumption per substance were examined. Solid phase extraction was followed by liquid chromatography-tandem mass spectrometry and a previously validated method was enhanced by adding new parameters (morphine, cotinine, and ethyl sulfate), and satisfactory results were obtained. In this study, alcohol, nicotine, and cannabis had the highest estimated per capita consumption with mean values of 29655.3 mL/1000 inh/day, 5507.6 mg/1000 inh/day and 3607.0 mg/1000 inh/day, respectively. These results were followed by heroin and cocaine consumption with mean values of 557.0 and 200.9 mg/1000 inh/day, respectively, whereas AMP-type stimulants had the lowest values among the targeted substances. METH and cannabis were also highly consumed drugs when compared with the results of other metropolitan cities, whereas heroin consumption was remarkably high owing to Turkey's location on a possible heroin trafficking route. Because Istanbul is the business center of the country and has the potential to attract tourists in all four seasons, meaningful seasonal consumption differences were not observed for all substances.

The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study.

BACKGROUND: The laparoscopic approach has emerged in the search for a surgical technique to decrease the morbidity associated with conventional repair of ventral hernias. In this study we aimed to compare the results of our open and laparoscopic ventral hernia repairs prospectively. METHODS: Between January 2001 and October 2005, a total of 46 patients diagnosed with ventral hernias (primary and incisional) who were admitted to our surgical unit and accepted to be included in this study group were examined. All patients were divided into laparoscopic repair (n = 23) and open repair (n = 23) subgroups in a randomized fashion. The patients' demographic characteristics, operation times, body mass indices, sizes of fascial defects, hernia locations, durations of hospital stay, presence and degrees of postoperative pain, and postoperative minor and major complications were analysed and compared. All the data were expressed as means +/- SDs. Chi-square and Wilcoxon tests were used for statistical analysis, and P < 0.05 was accepted as a significant statistical value (SPSS 11.0 for Windows). RESULTS: The demographic characteristics of both groups were similar. Women predominated, especially in the laparoscopy group (P < 0.05). The comparison of the results revealed that the major advantage of laparoscopy was the shortened postoperative hospital stay and the reduced incidence of mesh infection (P < 0.05, P < 0.05). On the other hand, operation time was significantly longer in the laparoscopy group (P < 0.05). The major complications encountered in the laparoscopy group were ileus and a missed enterotomy. The most frequent minor complication was seroma, which was significantly more frequent in the laparoscopy group (P < 0.05). Postoperative pain assessment revealed similar results in both groups (P > 0.05). CONCLUSIONS: The laparoscopic approach appears to be as effective as open repairs in the treatment of ventral hernias. Advanced surgical skill, laparoscopic experience and high technology are mandatory factors for successful ventral hernia repair.

'Use of electrothermal vessel sealing with LigaSure device during laparoscopic splenectomy'.

PURPOSE: Main causes of conversion to open surgery are uncontrolled bleeding from splenic hilum and capsular injury of spleen during laparoscopic splenectomy (LS). We present the use of LigaSure in laparoscopic splenectomy for hemostasis. MATERIAL & METHOD: Between January 2005 and May 2006, LS was performed in a total of 29 patients (6 male and 23 female) with a mean age of 35.44 +/- 13.63. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 20 patients, thrombotic thrombocytopenic purpura (TTP) in 2, hereditary spherocytosis (HS) in 3, lymphangioma in 2, hodgkin lymphoma in 1 and splenic cyst in one patient. LS was performed in the right semilateral position with three 10 mm trocars. LigaSure was used in dissection and division of splenic ligaments and hilar vascular structures. RESULTS: Conversion to open surgery was necessary in one patient due to peroperative bleeding. The mean duration of the operation was 71.3 +/- 19.8 minutes and the estimated blood loss was 85 +/- 23 ml. The diameter and the weight of the spleen were 10.7 +/- 2.68 cm and 250 +/- 90 g, respectively. There was no mortality. Postoperative complications included pancreatic fistula, trocar site infection and deep venous thrombosis that were encountered in three patients. These were managed without morbidity. The overall complication rate was 10.3% (n = 3). The mean duration of postoperative hospital stay was 2.86 +/- 1.59 days. CONCLUSION: LigaSureTM use in LS had easy application, provided sufficient hemostasis, and shortened the operative time.

Laparoscopic treatment of splenic lymphangiomas: report of three cases.

BACKGROUND AND AIM: Since 1991, laparoscopic splenectomy has been performed in many different pathologies of the spleen. Although it is a rare lesion, splenic lymphangiomas are cystic lesions of the spleen requiring splenectomy. Herein, we present three females who have undergone laparoscopic splenectomy with the diagnosis of cystic splenic lymphangioma. PATIENTS AND METHODS: In the last four years, in Istanbul Medical School, Department of General Surgery (Turkey) and in University of Catania Medical School, Department of Surgery (Italy), we performed laparoscopic splenectomy in three cases of splenic lymphangioma. RESULTS: These three female patients, with the age of 26, 30 and 40, had nonspecific abdominal pain requiring abdominal CT scan and magnetic resonance imaging, which showed incidental cystic lesions in the spleen, associated with cholelithiasis in one case. Preoperative laboratory tests and physical examinations were normal. Laparoscopic splenectomy was performed successfully with three 10 mm trocars in two patients in less than 1 hour, and with an Hasson trocar, two 5 mm trocars and one 10-12 mm trocar in the last case, who required simultaneous cholecystectomy. No peroperative and postoperative complications has occurred. Histopathological examinations confirmed the preoperative diagnosis. CONCLUSION: Laparoscopic splenectomy is the best treatment for patients with suspected cystic lymphangioma. It permits a total pathological examination of the spleen, and it should be preferred to partial splenectomy because of possible multiple lesions. In conclusion, minimal invasive treatment of this rare pathology is an effective and safe procedure.

Endoscopic retroperitoneal adrenalectomy.

BACKGROUND: The anterior transabdominal approach for adrenalectomy is associated with a longer postoperative recovery period than a posterior extraperitoneal adrenalectomy. The posterior approach is useful for patients requiring bilateral adrenalectomy or in those undergoing unilateral adrenalectomy for benign adenomas smaller than 5 cm. Recently transabdominal laparoscopic adrenalectomy has been used in patients with adrenal tumors. Endoscopic retroperitoneal adrenalectomy (ERA) is an alternative method that provides excellent exposure and should be associated with less postoperative morbidity. METHODS: Between 1993 and 1994 11 ERAs were performed in eight patients in the Department of Surgery, Istanbul Faculty of Medicine. The patients were placed in the prone semijackknife position on the operating table. After the retroperitoneal space was expanded with a balloon trochar, four 10 mm trochars were placed to perform the procedure. RESULTS: Among the eight female patients 23 to 65 years of age (mean, 42 +/- 12.4 years), three had bilateral adrenal hyperplasia caused by Cushing's disease, three patients had functioning adenoma, one patient had nonfunctioning adenoma (three on right and one on left adrenal), and one patient had right adrenal cyst. The mean operation time was 150 minutes (range, 90 to 300 minutes). No changes in PCO2 values have been found during intraoperative blood gas analyses. No intraoperative or postoperative complications occurred. All patients were discharged on the third postoperative day. CONCLUSIONS: ERA is a new and safe method of adrenalectomy. It is less invasive than the posterior approach. Patients treated by ERA seem to experience less postoperative pain and discomfort and have a shorter postoperative hospitalization and recovery period.

Laparoscopic treatment of hepatic hydatid cysts.

BACKGROUND: Because of limited experience worldwide, controversies about the laparoscopic treatment of liver hydatid cysts have not been resolved. The aim of this study was to describe the technical details of a laparoscopic method we developed in 1992 and report the initial results from an endemic area. METHODS: Of the 30 consecutive patients with 33 liver hydatid cysts considered for laparoscopic treatment during a 6-year period at a university hospital in Turkey, conversion to an open procedure was required in 7 patients (23%) while 23 patients with 25 cysts were able to be treated laparoscopically. RESULTS: By using a special trocar to suspend the cyst against the abdominal wall, laparoscopic simple drainage was performed in 16 patients (70%) and unroofing and drainage in 6 patients (26%). Pericystectomy was performed in 1 patient (4%). Complications were observed in 1 patient (4%) perioperatively and 4 patients (17%) postoperatively. Eleven patients (48%) were followed-up for a mean of 17 months (range, 3-72 months) and 1 recurrence (9%) was detected. CONCLUSIONS: This report is a very large experience with the laparoscopic treatment of liver hydatid cysts in the literature. We have established a technique yielding a comparable morbidity and recurrence rate to open series in early follow-up. We advocate that it is a safe and simple technique with potentially a decreased risk of intra-abdominal spillage compared with the other laparoscopic methods described.

An unusual recurrence to the neck after complete resection of hepatocellular carcinoma.

A case of hepatocellular carcinoma is presented. Work up at the time of resection revealed no evidence of metastasis. Two months later the patient developed an unresectable mass in his neck which invaded the second cervical vertebral body. This unusual metastasis is an indication that as one site of tumor is increasingly successfully cleared, we are likely to find more examples of tumor spread not seen previously.

Activated protein C resistance and false type 2 protein C deficiency detected after multiple shunt failures in a patient with hydrocephalus.

A 2-year-old hydrocephalic boy who had suffered multiple shunt failures was evaluated for hypercoagulability after a thrombus was removed from his right atrium. The work-up revealed that the patient had the heterozygous form of activated protein C resistance and false type 2 protein C deficiency by the clotting method. His protein C activity was normal by the chromogenic method. We suggest that patients having hydrocephalus, shunt-associated thrombus formation, or both should be evaluated for thrombophilic disorders, and protein C activity should be measured by chromogenic assay in patients with documented activated protein C resistance.

Pseudoaneurysm formation in surgically treated Behçet's syndrome--a case report.

Behçet's syndrome is a multisystem disorder with unknown etiology. Clinically it is mostly seen as a systemic vasculitis; almost 30% of the patients have vascular involvements, and most of these are venous thrombosis and arterial aneurysms. Obstructions of the femoral and tibial arteries have also been reported in the literature. The authors present here a patient with Behçet's syndrome who had pseudoaneurysms on both femoral arteries after aortobifemoral bypass surgery.

Growth of multiple hydatid cysts evaluated by computed tomography.

A case of multiple hydatid cysts, of embolic origin from a cyst of the left atrium, is discussed. The patient was first admitted to hospital with an intracerebral haemorrhage and was treated conservatively. There was not any cystic or mass lesion other than intracerebral haemorrhage on his computed tomography (CT) scans. In the follow-up period, the CT scans after 14 months showed multiple hydatid cysts, with the largest about 6 cm in diameter, which suggested a growth rate of 5 cm per year.

Bicuspid aortic valve and coarctation of aorta.

Bicuspid aortic valve (BAV) and coarctation of aorta (COA) are frequently seen together. It is believed that these malformations result from a single developmental diathesis. A case is presented of COA, aortic stenosis and aneurysm of the ascending aorta corrected by patch aortoplasty and commisurotomy. An aneurysm at the site of the coarctation repair can develop as late as 20 to 25 years after surgery. Almost all of the aneurysms described have occurred in patients undergoing patch aortoplasty. We do not recommend this technique except in special cases.

Human brains found in a fire-affected 4000-years old Bronze Age tumulus layer rich in soil alkalines and boron in Kutahya, Western Anatolia.

Undecomposed human bodies and organs always attracted interest in terms of understanding biological tissue stability and immortality. Amongst these, cases of natural mummification found in glaciers, bog sediments and deserts caused even more attention. In 2010, an archeological excavation of a Bronze Age layer in a tumulus near the Western Anatolia city Kütahya revealed fire affected regions with burnt human skeletons and charred wooden objects. Inside of the cracked skulls, undecomposed brains were discernible. To analyze the burial taphonomy of the rare phenomenon of brain preservation, we analyzed brains, bone, teeth and surrounding soils elements using Inductively Coupled Plasma-Mass Spectrometer (ICP-MS). Adipocere formation or saponification of postmortem tissue fat requires high levels of alkalinity and especially potassium. Indeed, ICP-MS analysis of the brain, teeth and bone and also of the surrounding soil revealed high levels of potassium, magnesium, aluminum and boron, which are compatible with the famous role of Kütahya in tile production with its soil containing high level of alkalines and tile-glazing boron. Fatty acid chromatography revealed simultaneous saturation of fats and protection of fragile unsaturated fatty acids consistent with soil-presence of both pro-oxidant and anti-oxidant trace metals. Computerized tomography revealed protection of diencephalic, metencephalic and occipital tissue in one of the best-preserved specimens. Boron was previously found as an intentional preservative of Tutankhamen and Deir el Bahari mummies. Here, in natural soil with its insect-repellant, anti-bacterial and fire-resistance qualities it may be a factor to preserve heat-affected brains as almost bioporcellain specimens.

Successful use of recombinant factor VIIa (NovoSeven) during cardiac surgery in a pediatric patient with Glanzmann thrombasthenia.

Glanzmann thrombasthenia is a rare, hereditary, congenital disorder of platelet function characterized by inappropriate bleeding that is difficult to control. Recombinant activated factor VII (rFVIIa) is a new treatment that is used to stop bleeding and provide surgical support for these patients. This report describes the use of rFVIIa to prevent serious bleeding during and after open-heart surgery in a child with Glanzmann thrombasthenia.

Laparoscopic treatment of accessory splenic tissue.

A case of persistent thrombocytopenia after open splenectomy for immune thrombocytopenic purpura is presented. The accessory splenic tissue found by CT preoperatively was successfully treated using a laparoscopic technique. The management of this first case in the world literature of accessory splenic tissue is reviewed.

Laparoscopic cholecystectomy in a tertiary referral center.

Analysis of the first year's experience of 94 patients in a tertiary referral center showed that 21% had had previous surgery. Fifty-seven percent had medical problems: 17.8% hypertension, 16% cardiac problems, 8.9% diabetes mellitus, and 6.2% chronic renal insufficiency. Four patients had hypercarbia and were acidotic. The conversion rate to open cholecystectomy was 8.7%. Only one patient required reoperation for a bile leak. Fifty-five percent of our procedures took < or = 2 h, but 45% took > or = 3 h. Just over 50% of our patients stayed 48 h postoperatively. In this complex group of patients, it appears possible to achieve results similar to those previously published, but more time was required for surgery, and length of stay was increased.

The effect of intraoperative colonic lavage with NG-nitro-L-arginine methyl ester (L-NAME) on anastomotic healing in the presence of left-sided colonic obstruction in the rat.

The effect of intraoperative colonic lavage with NG-nitro-L-arginine methyl ester (L-NAME) on the healing of colonic anastomosis in the presence of a left-sided obstruction in the rat was investigated. Left-sided colonic obstruction was created in 144 Wistar rats. The obstruction site was excised 24h later and anastomosis was performed after either no irrigation or colonic lavage with either saline, povidone iodine (PI), short-chain fatty acids (SCFA), L-NAME, or glutamine, in 24 animals each. Animals were killed on days 3 and 6, and a 4-cm colonic segment with the anastomosis at the center was excised. Bursting pressure (BP) and hydroxyproline (HP) content were measured. In the saline, PI, and SCFA groups, BP was higher (P < 0.05, P < 0.05, and P < 0.001, respectively) and HP concentration was similar compared with controls. Both the BP and HP concentrations were higher in the glutamine group compared with controls (P < 0.001). BP was lower (P < 0.05) and HP concentration was similar in the L-NAME group compared with the control group. Colonocyte nutrition and tissue perfusion are the mainstays of anastomotic healing. Intraoperative colonic lavage with L-NAME suppresses colonic anastomotic healing in the presence of a left-sided obstruction.

Spontaneous perirenal haematoma due to polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a systemic disease which involves the kidneys in 70% of cases. We report a case in which the pre-operative diagnosis was perirenal abscess or perirenal tumour, but at operation a perirenal haematoma was found. After pathological examination, it was recognised as renal involvement with PAN. The diagnosis of PAN is often difficult. Renal arterial changes, including aneurysm formation, are frequent. Since Kussmaul and Maier first described PAN in 1866, diagnosis has remained difficult because it is based upon tissue examination obtained at biopsy or post-mortem. In this report we present a case of renal involvement of PAN resulting in a perirenal haematoma due to spontaneous rupture of intrarenal arterial aneurysms.