Intraabdominal abscess related fungaemia caused by Rhodotorula glutinis in a non-neutropenic cancer patient.

Rhodotorula glutinis is a rare fungal infection that is especially observed in immune-compromised patients. It is common in the skin, faeces, nails, sputum, gastrointestinal system and adenoid tissue. However, the incidence of Rhodotorula glutinis is increased in both local and systemic infections in recent years. Presented here is a case of Rhodotorula glutinis fungaemia that isolated from subhepatic abscess formation and blood in a patient who was operated with Roux-en-Y technique due to gastric adenocarcinoma. Fungal sepsis is an important cause of fever resistant to antibiotic therapy that is often taken into marginal account. It should instead be particularly considered in patients with a history of intraabdominal surgery and non-neutropenic cancer patients. The case described illustrates an episode of systemic infection by Rhodotorula glutinis, correlated with the presence of intraabdominal abscess and without central venous catheters. This is the first case of fungaemia by Rhodotorula glutinis with an intraabdominal abscess source reported from Turkey.

Spontaneous cholecystocutaneous fistula as a rare complication of gallstones.

Spontaneous perforation of gallbladder as a complication of biliary stones may lead to a cholecystocutaneous abscess or fistula. The pathophysiology of this condition has been associated with increased pressure in the gallbladder, secondary to biliary obstruction. Ultrasonography and Computed Tomography (CT) can be used for diagnosis of cholecystocutaneous abscess or fistula. The treatment of fistula requires adequate drainage, antibiotics, followed by elective cholecystectomy with excision of the fistula. We report a case of spontaneous cholecystocutaneous fistula in an 89-year-old female patient who presented with obstructive jaundice and subcutaneous abscess in the right subcostal area. Abdominal CT scan showed gallstones and communication between the abscess and the gallbladder. First abdominal wall abscess was drained externally then cholecystectomy and exploration of common bile duct was performed (Fig. 3, Ref. 8).

The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study.

PURPOSE: The two most common procedures for open tension-free groin hernia repair with prosthetic mesh are the Lichtenstein operation and the mesh plug (Rutkow-Robbins) technique. Our study evaluated these two techniques on testicular blood flow and volume, and sperm function in young adults. METHODS: We randomized operation types with a systematic sampling method, and handled consecutive patients of age 20-30 years having unilateral inguinal hernia repair at our institution from March to August 2008. The study subjects were divided into the Lichtenstein group (LG) and the mesh plug group (MPG). All subjects received color Doppler ultrasonography to determine testicular volume and resistive index (RI) the day before surgery and 3 months postoperatively by a physician blinded for the type of planned or performed operation. Spermiograms done preoperatively and at 3 months postoperatively measured sperm concentration and the rate of progressive motility. RESULTS: Sixty-four patients met the study criteria, with 32 patients each in the LG and MPG. RI levels were elevated postoperatively in both the LG (P = 0.027) and MPG (P = 0.012); there was no significant alteration in terms of testicular volume and spermiogram in the LG and MPG. CONCLUSION: The Lichtenstein and mesh plug techniques in unilateral inguinal hernia increase the RI level significantly in the early postoperative period, but do not have a significant effect on sperm concentration and the rate of progressive motility.

Ischemia-reperfusion injury in the liver during renal transplantation: does perfusion solution play any role?

The effect of ischemia-reperfusion (I/R) injury within a transplanted kidney has not been reported on the liver as a remote organ. One hypothesis is that there is no difference between kidney perfusion solutions regarding antioxidants in liver after an I/R injury. We used four pigs with Ringer's lactate (RL); four with university of Wisconsin (UW); and two in a control (C) group. A liver parenchymal biopsy was obtained before renal artery/vein solution clamping for 20 minutes. Either RL or UW solutions were infused through arterial cannulas for 20 minutes as previously described elsewhere. For the sham group, we used 0.9% NaCl. After reperfusion for 20 minutes, we obtained a second liver parenchymal biopsy. Measurements of superoxide dismutase (SOD), glutathione peroxidase (GP-x), and malondialdehyde (MDA) levels were compared using paired student t tests within groups and analysis of variance between groups. The results were expressed as mean values +/- SEM with P < .05 accepted as significant. Although GP-x, SOD, and MDA decreased after ischemia-perfusion-reperfusion injuries in all groups, except MDA in UW and SOD, and MDA in C groups; only the MDA for C was significant (P = .04) Comparing the groups, GP-x (P = .01) and MDA (P = .003) levels after ischemia-perfusion-reperfusion were significant while changes in SOD levels did not show any difference (P > .05). In a kidney transplantation model, the liver was affected during the ischemia-perfusion-reperfusion process as evidenced by antioxidant enzymes. The pathophysiology and clinical importance of this phenomenon requires further study. Comparing the perfusion solutions, no difference was found between RL and UW regarding their effects to decrease renal I/R injury on the liver in pigs.

Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.

Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.

Effects of perfusion solutions on kidney ischemia-reperfusion injury in pigs.

During ischemia-reperfusion, free oxygen radicals which directly affect renal cells may cause delayed graft function. We investigated whether there was a difference regarding antioxidant enzyme content between use of Ringer's lactate (RL) versus University of Wisconsin (UW) perfusion solutions in kidney transplantation. Ischemia was achieved by clamping the renal pedicle for 20 minutes followed by perfusion with either solution for 20 minutes and reperfusion for another 20 minutes. A parenchymal biopsy was taken before and after the ischemia, perfusion, and reperfusion (IPR) process. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and malondialdehyde (MDA) were investigated in the biopsy specimens. We used paired t tests within groups and t tests for comparisons between groups. The results were expressed as mean values +/- SEM with P < .05 accepted as statistically significant. After IPR, SOD, GPx, and MDA were decreased in all groups: only GPx (P = .001) and MDA (P = .04) for the RL group and SOD (P = .001) and MDA (P = .05) for the UW group were statistically significant. In the control group, we did not observe any difference (P > .05). Comparisons between groups did not reveal differences (P > .05). In our study, no difference was observed between RL and UW regarding their effects on antioxidant enzymes following renal I/R injury in pigs. More investigations are needed to evaluate graft function in this setting.

Do we need to use subcutaneous suture for pilonidal sinus treated with excision and simple primary closure?

OBJECTIVE: Pilonidal sinus (PS) is a chronic intermittent disease. There are numerous surgical treatment procedures that have been previously reported, yet none have been proved to be ideal. The main issues concerning the surgical treatment of PS are simplicity and cost-effectiveness. This study is designed to research the possibility of decreasing operation costs in the excision and simple primary closure technique of PS by omitting subcutaneous suture usage. MATERIALS AND METHODS: 152 male patients with chronic PS were included in the study. All patients were treated with excision and simple primary closure technique and randomized into two groups. Group-I (n = 74) received subcutaneous closure with 2/0 polyglactin sutures, but Group-II (n = 78) did not. Wound edges were re-approximated by using deep interrupted matress 0 no polypropylene sutures in both groups. RESULTS: In Group-I; overall 7 (9.5%) early complications were noted; 2(2.7%) wounds broke down and 5 (6.7%) experienced superficial wound infections. Any late wound complications were noted. A total of 98 polypropylene and 104 polyglactin sutures were used. In Group-II; overall 5 (6.4%) early wound complications were noted; 3 (3.8%) had wound dehiscence and 2 (2.6%) developed superficial wound infections. Also, 1 (1.3%) late wound complication (wound dehiscence) occurred. Overall 104 polypropylene sutures were used. CONCLUSION: Excision and simple primary closure is a simple and cost effective surgical procedure in the treatment of PS. Omitting the use of subcutaneous sutures makes the procedure simpler and decreases the operation costs.

Effect of hyperbaric oxygen on experimental acute distal colitis.

It has been demonstrated that hyperbaric oxygen (HBO) is useful as an adjunctive therapy for Crohn's disease. However, its effects on ulcerative colitis have not been investigated. In the present study, HBO was tested for acetic acid-induced colitis, and antioxidant systems were evaluated to clarify its possible mode of action. Thirty-six Sprague-Dawley rats were randomly divided into three groups: sham control (Group I), colitis induced by acetic acid without any therapy (Group II), colitis induced by acetic acid and treated with HBO (Group III). HBO was given for 5 days, 2 sessions per day at 2.5-fold absolute atmosphere pressure (ATA) for a period of 90 min in rats in which colitis had been induced (Group III). Rats were sacrificed on the 5th day after the procedure. Superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH Px) activity were measured in the intestinal tissue and erythrocyte lysate. MDA and GSH Px were also determined in the plasma. Whereas MDA levels in erythrocyte, plasma and intestinal tissue were decreased, the levels of GSH Px and SOD were significantly increased in Group III as compared to those of Group II. The results of our study suggest that hyperbaric oxygen therapy has beneficial effects on the course of experimental distal colitis and that antioxidant systems may be involved in its mode of action.

Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy.

Combined chemotherapy and radiation therapy is the standard treatment for epidermoid carcinoma of the anal canal. Failures are often not associated with distant recurrence and are therefore potentially amenable to salvage abdominoperineal resection. The aim of this study was to review our experience with abdominoperineal resection following failure of chemoradiation therapy for epidermoid carcinoma of the anus. Between 1980 and 1998, 17 patients underwent salvage abdominoperineal resection following failure of chemoradiation therapy. Four patients were excluded from survival analysis because resection was performed with palliative intent. Survival curves were based on the method of Kaplan and Meier, and univariate analysis of predictive variables was performed using the log-rank test. Twelve patients underwent abdominoperineal resection for persistent disease and five patients for recurrent disease. No operative deaths occurred, but local complications including perineal wound infection and wound breakdown was seen in 8 of 17 patients and 6 of 17 patients, respectively. Patients undergoing omental flap reconstruction (n = 3) or no pelvic reconstruction (n = 5) had a higher incidence of perineal breakdown compared to those undergoing muscle flap reconstruction (n = 9) (P <0.05). The median follow-up time for the patients operated on with curative intent was 53 months. The 5-year actuarial survival was 47%. Potential prognostic factors that were not found to have an impact on survival included margin status of resection, sphincter invasion, and degree of differentiation. Only pathologic tumor size greater than 5.0 cm (P <0.001) and age over 55 years (P <0.05) adversely affected survival. Selected patients with recurrent or persistent anal carcinoma following chemoradiation therapy can be offered salvage abdominoperineal resection. This operation is associated with a high incidence of local wound complications, and muscle flap reconstruction should be considered when possible. Prolonged survival can be achieved in some patients following salvage resection for epidermoid carcinoma of the anal canal.