Is advanced age a significant risk factor for laparoscopic cholecystectomy?

AIM: have been a few reports about the outcome of laparoscopic cholecystectomy (LC) in the elderly patients. The aim of this study was to assess if morbidity and mortality may be increased in the geriatric patients because of high incidence of co-morbidity. METHODS: From November 2000 to January 2009, 146 patients aged 60 years and older who underwent LC were reviewed. Patients were placed into two groups by ages: Group A (age = 60-74 years, N.=126), Group B (age ≥ 75, N.=20). RESULTS: One hundred forty six patients underwent LC for benign gallbladder disease during this study period There was no difference in operative time, ASA, distribution of sex between the two groups. Most patients were treated with LC for symptomatic cholelithiasis (82.5%) in both groups. There were sixty eight cases (53.96%) in the Group A and 14 (70%) patients in the Group B had co-morbid diseases (P>0.005). Conversion rates and morbidity was not different significantly according to ages for either group (P>0.05). The rate of conversion to OC was 9.5% in the Group A and 5% in the Group B. Five complications were occurred in the four patients. There was only one bile duct injury in the Group A. Conversion rates and postoperative complications were not affected by gender and co-morbid diseases (P>0.05) in our study whereas acute cholecystitis were found as a risk factor for conversion to open surgery and complications according to the cases preoperatively diagnosis (P=0.001). CONCLUSION: LC should be recommended with acceptable morbidity and mortality in the elderly. Morbidity and conversion to OC are not increased with advanced age even in the extremely elderly patients. Acute cholecystitis is correlated with a high risk factor for morbidity and conversion to OC.

Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.

Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study.

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

Preperitoneal mesh repair of spigelian hernias under local anesthesia: description and clinical evaluation of a new technique.

We report on a new method for the repair of spigelian hernia, in which we combined the step-by-step local anesthesia and open preperitoneal mesh repair techniques. After initial infiltration of local anesthetics, we incised the attenuated fascia and slightly enlarged the fascial defect to facilitate easy return of hernial content into the abdominal cavity. We injected preperitoneally, in a radial fashion around the peritoneal sac, more saline solution, consisting of 1:200,000 epinephrine (g:g) and 1/3 bupivacain (v:v). We dissected the peritoneum away from the anterior abdominal wall to create a preperitoneal pocket of sufficient size. We spread open a 9 x 9-cm polypropylene mesh in the area, as if we were doing a GPRVS of Stoppa. We followed up our four patients for an average of 32 months. All four cases had an uneventful recovery and were discharged in an average of 3.5 days. They returned to normal daily activity on the 9th day after surgery. We suggest that the preperitoneal mesh repair of a spigelian hernia under local anesthesia is a simple and feasible technique with favorable early and late postoperative results and deserves further investigation in larger series.

Morgagni hernia: rare presentations in elderly patients.

Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when complications occur. Herein we present two elderly patients with Morgagni hernia, which were complicated with bowel perforation and upper gastro-intestinal bleeding. The recognition and management of these cases are discussed.

Evaluation of lymphatic drainage of cold thyroid nodules with intratumoral injection of Tc-99m nanocolloid.

PURPOSE: The lymphatic system may show variations throughout the entire body. Knowledge of the variations and aberrant lymph drainage are important when planning surgical treatment and radiotherapy. The aim of this study was to evaluate the intratumoral injection technique in the detection of lymphatic drainage of proved or possibly malignant cold thyroid nodules. MATERIALS AND METHODS: The study group consisted of 13 patients with palpable solitary cold thyroid nodules. None of the patients had cystic nodules on ultrasound examination. After fine-needle aspiration biopsy (at least 3 days later), 15 MBq (0.4 mCi) Tc-99m nanocolloid particles in a small volume (0.2 ml) were injected into the nodule. Dynamic images (60 frame x 1 minute) were acquired during the first hour, followed by static anterior and lateral images at 90 and 120 minutes. RESULTS: Radiopharmaceutical was present in the systemic circulation in two patients, possibly as a result of paratumoral injection. Eleven patients had intratumoral accumulation in early frames. Lymph nodes draining the thyroid nodule were visualized in 10 of 11 patients. In the dynamic acquisition period of 7 of 10 patients, the first draining lymph node could also be identified. Only 5 of 13 patients had malignant nodules. Lymphatic metastases were detected in one patient's specimens. CONCLUSIONS: Preoperative visualization of lymphatic pathways may be used when planning for thyroid cancer surgery. Sentinel node detection could yield valuable additional information in these patients.

Mesh repair of a pelvic bone defect caused by a migrated acetabular cup.

Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.

[Acute pancreatitis and hyperlipidemia in females. Is pregnancy contraindicated? An analysis of two cases]. / Bayanlarda hiperlipidemi ve akut pankreatit: gebelik kontrendike midir? Iki olgunun incelenmesi.

Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition for both mother and fetus. In this article, we reported two cases suffered from acute pancreatitis and hyperlipidemia; 24-year old pregnant women and 40 year old non-pregnant women. The risks of the pregnancy in this situation were also discussed.

The quality of abortion services in Turkey.

The quality of abortion in Turkey's public sector hospitals is investigated using multiple research methods including observations of actual procedures, interviews with medical staff and clients, and an inventory of materials and equipment. The results suggest that women who obtain abortions in public sector hospitals have a higher abortion rate than the general population. They are likely to receive a vacuum aspiration with minimal pain control medication. Clinical infection control procedures are insufficient, as are interpersonal communication practices including counseling on reproductive health issues and providing factual information. Links with family planning services are strong and the majority of abortion patients who desire family planning receive a contraceptive method, either through direct provision of postabortion contraceptives or referral.

Operational research for an effective information and training approach for surgical contraception knowledge and attitude in Turkey.

PIP: Although 70% of all currently married women in Turkey state that they do not want to have any more children, only 34.5% use modern contraceptive methods and 28.1% use traditional methods such as withdrawal. Women in Turkey have 17 induced abortions for every 100 pregnancies. Voluntary surgical contraception (VSC) was legalized in 1983, but it was inadequately and poorly presented to the public as a viable contraceptive option. VSC is therefore less well-known than other contraceptive methods. The 1993 Turkish Demographic and Health Survey and the 1988 Turkish Population and Health Survey found that only 1.3% of couples in Turkey used tubal ligation and/or vasectomy in 1983, 1.8% in 1988, and 2.9% in 1993. A study was conducted in the Etimesgut and Golbasi districts of Ankara, rural and semi-rural areas which consist of 27 villages, to identify the most effective information and education approach to increase knowledge and change attitudes toward surgical contraception. 850 of the 1176 couples included in the intervention study were accessible for the follow-up study. The following approaches were applied to three intervention groups: wives were informed by a midwife, husbands were informed by a male health officer, and both were informed concurrently by the respective trainers. Increase in knowledge scores on surgical contraception was higher in groups in which women were trained directly. However, although the scores of knowledge increased, the training intervention caused no significant change in attitude.^ieng

[Is adolescent fertility a problem in Turkey?]. / Turkiye'de gencler arasinda dogurganlik bir sorun mudur?

PIP: The population of Turkey was about 50 million in 1985, and the 15-19 age group was 5.5 million, 10.7% of the total population. Almost half of this 5.5 million were females, the mean age at first marriage was 18.2 years and 15.6% of this group were married. The fertility rate of the 15-19 age group was 64.1 per thousand. These figures show that early marriage and early pregnancy are the main problems. The prenatal care in adolescent pregnancies which present high risks for the mother and the child usually starts in the last trimester (average: 7.15 months) and 31.6% of the deliveries take place under unsuitable conditions. The use of contraceptives in this age group is 34.5% (23.4% traditional methods, 11.1% modern methods). The main solution of the problem, that is, adolescent pregnancy, is increasing the age at first marriage. But until this goal is reached, for healthier mothers and children, prenatal care should be given earlier in adolescent pregnancy and deliveries should take place under the supervision of health personnel. (author's)^ieng

[An epidemiologic study of the antibiotic susceptibility of bacteria isolated from patients with urinary tract infections]. / Uriner sistem infeksiyonlarindan izole edilen bakterilerin antibiyotik duyarliliklari ile ilgili epidemiyolojik bir çalisma.

This epidemiological Study is held in Saglik Sosyal Yardim Bakanligi--Hacettepe Universitesi Tip Fakültesi Cubuk Research and Training area to find out the prevalence of urinary tract infections and to determine the antibiotic susceptibility of the causitive organisms. The prevalence of urinary tract infections in the area is 10%. E. coli is the most frequently isolated bacterium (40%). Amikacin, Cephotaxime, and Ofloxacine are the most effective antibiotics.

Can midwives be trained to insert IUDS? Results from Turkey.

PIP: Beginning in the 1960s, the Turkish government placed a emphasis on the importance of family planning in an effort to improve maternal and child health (MCH) services. While the IUD has proven adequate for women in Turkey, insertion and proper use have created problems. The IUD program has had difficulty in gaining the acceptance of male physicians in Turkey, and because there are few female physicians in the country, a problem with implementation of the program arose. 1 solution suggested that non-physician personnel learn to insert the IUD and be able to examine IUD patients. Assistant nurse-midwives were surveyed in a 3-phase project carried out by the staff of the Department of Public Health of Hacettepe University in Ankara with WHO. In the 1st phase, a training method was created with competence comparison of the assistant midwives to physicians following in the 2nd phase. The 3rd phase of the project studied the use of non-physician services throughout the country. It was found that assistant nurse-midwives were equally capable of IUD insertions and check-ups and that IUD services can now reach rural areas of the country beyond the range of traditional medical services.^ieng