The Whitehead operation procedure: Is it a useful technique?

OBJECTIVE: Hemorrhoidal disease is a very common entity in the general population; however, the therapeutic approaches to hemorrhoids remain controversial. The choice of treatment method depends on the grade of the hemorrhoid as well as the experience of the surgeon. The Whitehead hemorrhoidectomy procedure is often applied for grade IV hemorrhoids. MATERIAL AND METHODS: We studied 49 patients who underwent surgery between December 1982 and January 2013. The indications for the Whitehead procedure in all patients were grade IV hemorrhoidal disease. The data on these patients were evaluated retrospectively with respect to age, gender, preoperative diagnosis, and postoperative complications. RESULTS: Of the patients included in this study, 34 were male and 15 were female. The mean age of the patients was 41.93±12.42, and the age range was 24-70 years. Complications of the Whitehead procedure included bleeding (6.12%, three cases), stricture (2.04%, one case), urinary retention (16.33%, eight cases), and temporary anal incontinence (2.04%, one case). No patients developed Whitehead deformities, entropion, or infectious complications. All patients were discharged from hospital between the fifth and eighth days post-surgery (6.45±1.00 days). The follow-up period was 1-234 months (70.02±54.89). CONCLUSION: The Whitehead procedure is successful in patients with prevalent peripheral prolapse and/or thrombosed hemorrhoids. With the right indications, and if the surgeon has adequate experience, the morbidity rate of the Whitehead procedure is similar to that of other treatment methods.

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.

BACKGROUND: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. AIMS: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. STUDY DESIGN: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. METHODS: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. RESULTS: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. CONCLUSION: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Intraoperative nerve monitoring in thyroid surgery.

BACKGROUND: Nerve injury is one of the specific complications of thyroid surgery despite many advances in surgical technique. The recurrent laryngeal nerve (RLN) and the external branch of superior laryngeal nerve are the nerves at risk during thyroid surgery (1). Morbidity related to recurrent laryngeal nerve injury varies from changes in voice quality to severe dyspnea requiring tracheal intubation or tracheostomy. To minimize the risk of nerve injury, intraoperative nerve monitoring (IONM) being suggested as a tool for helping visual control for RLN has gained significant interest in recent years (1,2). We aimed to determine the effectiveness of nerve monitoring during thyroid surgery and to provide a clinical experience. MATERIALS AND METHODS: This study was performed from June 2010 to June 2012. We prospectively evaluated 94 patients who had thyroid surgery with or without nerve monitoring. Of those patients 48 were in monitored group (M) and 46 were in unmonitored group (UM). RESULTS: The mean age was 48 (27-76) in M group and 52 (73-17) in UM. There was only one patient had transient hoarseness in M group and also one patient had transient hoarseness in UM group. One each in both groups had persistent hoarseness. No patients experienced airway problem. Operation time was significantly shorter in M group (p<0.001). CONCLUSIONS: Use of a nerve monitoring system does not substitute for careful dissection and visual identification of nerves, but monitoring can assist the surgeon in identifying the RLN anatomic variability and may decrease the operation time during thyroid surgery.

Effects of oleuropein on serum inflammatory cytokines and histopathological changes in rats with pancreatitis.

OBJECTIVES: Acute pancreatitis is a severe debilitating disease with high morbidity and mortality. The severity of the disease is largely due to the actions of various inflammatory mediators. No specific therapy is indicated for AP and its treatment remains largely supportive. This study investigated the effect of oleuropein on serum inflammatory cytokines and distant organ injury in rats with acute pancreatitis induced by bile-pancreatic duct obstruction. MATERIAL AND METHODS: Thirty adult male Wistar rats were randomly assigned to 3 groups of 10 rats each: group I: sham, group II: pancreatitis and group III: pancreatitis+oleuropein. Rats in Group III received oleuropein 20 mg/kg intragastrically during 10 days before surgery. The rats were sacrificed at 24 h after surgery and venous blood, pancreatic and lung tissue samples were obtained for analysis. RESULTS: A statistically significant difference was found between groups regarding serum amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α values with a Kruskal-Wallis test (p<0.05). No statistically significant difference was found between Group II and III regarding pairwise comparison of amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α value by using pairwise comparisons with a Mann-Whitney U test (p>0.01). A statistically significant difference between groups was found regarding edema, inflammation, hemorrhage and acinar cell necrosis in histopathological examination of the pancreas (p<0.05). No difference was found between group II and III (p>0.01). A difference was found between the groups in terms of lung tissue edema (p<0.05) but no difference was found regarding hemorrhage and inflammation (p>0.05). No statistically significant difference was found between group II and III with pairwise comparison (p>0.01). CONCLUSIONS: The experimental model used in this study showed to be appropriate for creation of acute pancreatitis. It was concluded that oleuropein as a prophylactic treatment has no protective effect on serum proinflammatory and anti-inflammatory cytokines as well as pancreatic tissue.

Protective effect of ethyl pyruvate on ischemia-reperfusion injury in rat ovary: biochemical and histopathological evaluation.

BACKGROUND: To investigate the protective effect of ethyl pyruvate (EP), an anti-oxidant agent, against ischemia-reperfusion injury in a rat model of ovarian torsion, considering biochemical and histopathological aspects. METHODS: Forty Wistar Albino rats were divided into five groups: Group I, sham operation; Group II, ischemia alone, Group III, ischemia-reperfusion; Group IV, ischemia-reperfusion+50 mg/kg EP; and Group V, ischemia-reperfusion+100 mg/kg EP. Through laparotomy, 360° torsion was performed and maintained for 3 h, and detorsion was maintained for a further 3 h. Intraperitoneal EP was given 30 min before the surgical procedure. Ovarian tissues and blood samples were obtained after surgery. Malondialdehyde (MDA) and asymmetric dimethyl arginine (ADMA) levels were measured in both plasma and tissue samples. Tissue sections were evaluated histopatologically. Analysis of variance was used for statistical analyses. RESULTS: In both serum and tissue samples, ADMA and MDA levels were found to be significantly lower in the EP groups compared with the ischemia alone and ischemia-reperfusion groups (p=0.0001). However, no significant difference was found between groups treated with 50 mg/kg or 100 mg/kg EP. On histopathological evaluation, the total tissue injury score was found to be lower in rats treated with EP. No significant difference was detected between groups treated with 50 mg/kg or 100 mg/kg EP. CONCLUSION: Ethyl pyruvate may exert positive effects in ischemia-reperfusion injury in cases of ovarian torsion. However, no difference was detected between 50 mg/kg and 100 mg/kg EP.

Effect of perceived social support on psychosocial adjustment of Turkish patients with breast cancer.

AIMS: To identify the psychosocial adjustment of Turkish patients with breast cancer and the effects of perceived social support on their adjustment. MATERIALS AND METHODS: The sample comprised 100 volunteering patients diagnosed with breast cancer in the last six months reporting to the Outpatient Chemotherapy Unit at the Medical Faculty Hospital in northern Turkey. The data for the study were collected through the Descriptive Information Form, the Psychosocial Adjustment to Illness Scale-Self-reflection (PAIS-SR) and the Cancer-Specific Social Support Scale and analyzed via SPSS 16.0 for Windows. Descriptive statistics, Chi square test, ANOVA and correlation were used to evaluate data. RESULTS: There was a negative significant correlation between mean scores in the sub-scales of the social support scale and the ones in the sub-scales of the psychosocial adjustment to illness scale (p<0.05). Similarly, there was a negative significant correlation between confidence support and health care orientation as well as adjustment to social environment. Likewise, emotional support was in a negative significant correlation with health care orientation, adjustment to domestic environment, extended family relationships and adjustment to social environment. CONCLUSIONS: It was concluded that social support for patients with breast cancer had an influence on their psychosocial adjustment to illness. Holistic care should be given to breast cancer patients by oncology nurses especially in the first six months of treatment. It could be concluded that patients should be accompanied by their family/relatives in treatment and care following their diagnosis with breast cancer, that their family should be made more aware of the fact that the patient should be physically and psychologically supported, that patients with breast cancer should be provided with domiciliary care, and that they should be encouraged to participate in social support groups.

Preventing intraperitoneal adhesions with linezolid and hyaluronic acid/carboxymethylcellulose: a comparative study in cecal abrasion model.

BACKGROUND: We aimed to compare the effectiveness of linezolid in preventing intraperitoneal adhesions with hyaluronic acid + carboxymethylcellulose (Seprafilm). METHODS: Thirty rats were divided randomly into 3 groups: Group I (control), untreated; Group II (Seprafilm); and Group III (linezolid). All rats were sacrificed on the 14th day after surgery. Macroscopic adhesion, inflammation, and fibrosis were evaluated. RESULTS: The multiple comparisons between groups showed a statistically significant difference for adhesion. There were statistically significant differences between Group I and II and I and III, but no statistically significant difference between Group II and III. The multiple comparisons between the groups showed a statistically significant difference for inflammation and fibrosis. For inflammation and fibrosis, there was a statistically significant difference between Group I and II and I and III, but no statistically significant difference between Group II and III. CONCLUSION: The efficiency of linezolid in reducing the formation of intraperitoneal adhesions was statistically significant compared with the control group.

Effect of Beta-glucan on intestinal anastomoses in a rat model.

OBJECTIVES: The authors aimed to investigate the effect of ß-Glucan on healing of an experimental left-sided colon anastomosis model. MATERIAL AND METHODS: Twenty adult male Wistar albino rats were randomized into two groups which had colonic transection and end-to-end anastomosis. Group I (Control): anastomosis group, received no treatment (n = 10); group II, anastomosis + ß-Glucan (50 mg/kg/day within seven days after surgical procedure). Bursting pressure, hydroxyproline levels and histopathological characteristics of the anastomosis were analyzed. RESULTS: The average burst pressure of Groups I and II were 106.67 ± 5.00 and 148.00 ± 11.35 mmHg and hydroxyproline levels were 0.85 ± 0.14 and 1.45 ± 0.46 µg/mg, respectively. Both the burst pressure and hydroxyproline levels in group II were statistically significantly higher (p < 0.05). Histopathological examination revealed less epithelial damage in group II (p < 0.05). Though not statistically significant, less edema and damage to the submucosal-muscular layer was seen in Group II (p = 0079). CONCLUSIONS: Due to significant increases in anastomotic bursting pressures and tissue hydroxyproline levels and considering the inhibitory effect of ß-Glucan on epithelial damage, edema, and submucosal-muscular layer damage, ß-Glucan was thought to contribute to the healing of the anastomosis.

The predictivity of serum biochemical markers in acute biliary pancreatitis.

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.

Is oval flap reconstruction a good modification for treating pilonidal sinuses?

BACKGROUND: Flap techniques are acceptable for the surgical treatment of pilonidal sinuses. This study assessed a new modification of the rhomboid flap technique. METHODS: The study included 133 patients with pilonidal disease who were treated between April 2004 and April 2009. The pilonidal sinus was removed with an oval excision, and an oval head rhomboid flap was prepared to reduce flap necrosis. RESULTS: The mean age of the patients was 27.4 ± 4.6 years (range, 13-80). The rate of minor postoperative complications was 11.3%. The mean hospital stay was 2.3 ± .8 days (range, 1-6). The rate of recurrence was 1.5%. Regarding cosmetic results, 116 (87%) patients were very pleased, 15 (11.2%) were pleased, and 5 (3%) were displeased. The mean follow-up period was 22.5 ± 12.4 months (range, 5-57). CONCLUSIONS: The oval flap reconstruction method is a recommended procedure that produces fewer ischemic flaps with a low rate of recurrence and acceptable cosmesis.

P53 codon 72 and HER2 codon 655 polymorphisms in Turkish breast cancer patients.

The polymorphisms in codon 72 of the tumor suppressor protein p53 (P53) gene and codon 655 of the human epidermal growth factor receptor 2 (HER2) gene have been suggested to play roles in most cancers. The purpose of this study was to investigate the association between common variants of HER-2 and P53 genes with breast cancer risk. Blood samples collected from 204 women with primary breast carcinoma and 192 healthy female controls were analyzed through polymerase chain reaction-restriction fragment length polymorphism methods. The frequencies of Arg/Arg, Arg/Pro, and Pro/Pro genotypes for P53 codon 72 were 51.7%, 41.4%, and 6.9% in patients and 42.6%, 47.3%, and 10.1% in controls, respectively. The frequencies of Ile/Ile, Ile/Val, and Val/Val genotypes for HER2 codon 655 were 75.0%, 22.5%, and 2.5% in patients and 73.4%, 25.0%, and 1.6% in controls, respectively. The genotype and allele frequencies between patient and control groups for P53 gene polymorphism were not significantly different (p = 0.177 and p = 0.07, respectively). Similarly, the genotype and allele frequencies between patient and control groups for HER2 gene polymorphism were not significantly different (p = 0.716 and p = 0.891, respectively). With the exception of association between the P53 codon 72 polymorphism and tumor stages (p = 0.026), there was no significant association between the studied polymorphisms and clinicopathological characteristics. The P53 gene codon 72 Arg/Pro and Her2 gene Ile655Val polymorphisms were not associated with the risk of breast cancer in Turkish women. However, significant associations between the P53 codon 72 and the homozygote and heterozygote Pro genotypes with tumor stages were found.

Comparative evaluation of adhesions to intraperitoneally placed fixation materials: a laparoscopic study in rats: adhesions to fixation materials.

After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to mesh had not been clarified. We examined adhesion formation specific to the fixation material in rats. We designed an experimental laparoscopy setup, and placed four intraperitoneal fixation materials on the peritoneum of rats without a mesh graft. Another group of researchers documented the incidence and intensity of postoperative adhesion formation. The adhesion scores for the nickel-titanium anchor were significantly greater than those for polylactic acid (p = 0.004), a titanium tacker (p < 0.0001), and fibrin glue (p < 0.0001). No adhesions occurred in the fibrin glue group. Fibrin glue is the preferred fixation material because it produced no postoperative adhesions. The nickel-titanium anchor produced heavy adhesions but may be applicable for recurrent hernia cases and in patients with thin abdominal walls.

Comparison of the adherence of E.Coli and S. Aureus to ten different prosthetic mesh grafts: In vitro experimental study.

BACKGROUND: The prosthetic mesh grafts used to repair the abdominal wall may become infected, primarily by S. aureus and E. coli. This study sought to provide a rational basis for the choice of mesh used to repair a hernia when there is a likelihood of infection or contamination. METHODS: S. aureus and E. coli were incubated with ten types of prosthetic mesh graft (Table 1) in liquid growth medium. After sequential dilution of samples from the prosthetic mesh grafts, the colony forming units of adherent S. aureus and E. coli were counted. RESULTS: There was no significant difference in the numbers of E. coli and S. aureus adherent to simple polypropylene mesh grafts. Significantly more of both species were adherent to the polyester, expanded polytetrafluoroethylene (ePTFE), and composite prosthetic mesh grafts, except for E. coli on graft 5. Significantly fewer E. coli were adherent to composite mesh grafts 5, 8, and 10 than S. aureus. CONCLUSION: S. aureus and E. coli adhere to polypropylene similarly. In vitro, fewer S. aureus and E. coli adhere to simple polypropylene mesh grafts than to polyester, ePTFE, or composite prosthetic mesh grafts.

Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report.

INTRODUCTION: Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis. CASE PRESENTATION: We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium. CONCLUSION: This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.

[Non-operative management of blunt hepatic trauma]. / Künt karaciger travmalarina konservatif yaklasim.

BACKGROUND: Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS: Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma's Organ Injury Scaling System. RESULTS: Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION: For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Endoscopy-assisted resection for multiple polyps of the small intestine in Peutz-Jeghers syndrome: a father and daughter story.

Peutz-Jeghers syndrome is an infrequently encountered disease with potential complications including bleeding, intestinal obstruction, intussusception, and malignant transformation. We report on two patients, father and daughter, with Peutz-Jeghers syndrome who were admitted to hospital with similar complaints of abdominal pain. The father was 37 years old and the daughter was 17. Physical examination and laboratory tests revealed small intestinal intussusception in both patients. In the daughter, the intussuscepted segment was resected. An electrosurgical snare was also used for enteroscopic excision of multiple jejunal and ileal polyps. In the father, two 4-cm polyps were surgically resected while an enteroscopic surgical snare was used for polyps of smaller size. Both patients were discharged on postoperative day 7.

Laparoscopic bilateral hernia repair using fibrin sealant: technical report of two cases.

Minimally invasive surgery is widely used in hernia repair given its advantages such as minimal disturbance to the surrounding tissues, shorter hospital stay, and promising long-term results. Efforts are still being made to make this minimally invasive procedure even more minimal. New tissue adhesives avoid the use of foreign materials and the postoperative pain that might be attributed to staples. We present the first two cases of bilateral inguinal hernia repair performed with a totally extraperitoneal procedure using fibrin sealant instead of staples for the fixation of the mesh.

Intra-abdominal ectopic thyroid presenting with hyperthyroidism: report of a case.

Ectopic thyroid tissue has been found in the developmental pathway of the thyroid gland and has also been reported in the abdominal cavity. Intra-abdominal thyroid tissue was totally resected around the mesentery of the small intestine in a 56-year-old woman. She had hyperthyroidism preoperatively and had also undergone a bilateral subtotal thyroidectomy 10 years earlier. No signs or symptoms of a thyroid tumor were present.