The role of SIRT2 inhibition on the aging process of brain in male rats.

Background: Though the exact mechanisms regarding brain aging and its relation to neurodegenerative disorders are not precise, oxidative stress, the key regulators of apoptosis and autophagy, such as bcl-2 and beclin 1, seem to be the potential players in the aging of the cerebral cortex and hippocampus. As a type of nicotinamide adenine dinucleotide (NAD+)-dependent deacetylases, sirtuin 2 (SIRT2) has been associated to age-related diseases. However, the exact role of SIRT2 in brain aging is not well studied. The objective of the current study was to study the role of SIRT2 inhibition on brain aging through the neuroprotective mechanisms. Methods: We tested the effects of AGK-2, a SIRT2 inhibitor, on oxidative stress parameters, apoptosis and autophagy regulators including bcl-2, bax, beclin1 in young and old rats. 24 Wistar albino rats (3 months-old and 22 months-old) were divided into four groups; Young-Control (4% DMSO+PBS), Young-AGK-2 (10 µM/bw, ip), Aged-Control, and Aged-AGK-2. Following the 30 days of drug administration period the rats were sacrificed and the cerebral cortex, hippocampus, and cerebellum were isolated. Total antioxidant status (TAS) and total oxidant status (TOS) were measured as oxidative stress parameters in all three brain regions. SIRT2, bcl-2, and bax protein expression levels were measured by western blot and gene expression level of beclin 1, Atg5, and SIRT2 by real-time PCR. Results: The bcl-2, bcl-2/bax ratio, beclin 1, and TAS in the cerebral cortex of the aged group were significantly decreased; however, the TOS, oxidative stress index (OSI), and SIRT2 expression in the cerebral cortex and hippocampus increased. SIRT2 inhibition by AGK-2 reduced TOS and OSI levels in all brain regions and increased bcl-2, bcl-2/bax ratio. In aged animals, AGK-2 also increased the beclin 1 levels in the cortex and hippocampus. Conclusion: Our results indicate that SIRT2 has an essential role in brain aging. The inhibition of SIRT2 by AGK-2 may increase cell survival and decrease aging related processes in the cerebral cortex and hippocampus via decreasing oxidative stress, and increasing bcl-2 and beclin 1 expression.

Assessment of palpitation complaints in patients with benign paroxysmal positional vertigo.

OBJECTIVE: The detection of cardiac arrhythmias during vertigo attacks along with the resolution of vertigo by treating the arrhythmias is defined as cardiac vertigo. The cause of palpitations that develop following attacks of non-cardiac vertigo is unknown. We aimed to investigate the effect of benign paroxysmal positional vertigo (BPPV) on the cardiac conduction system and evaluate patients' palpitation complaints using 24-hour ambulatory ECG (Holter) monitoring. PATIENTS AND METHODS: Sixty-five patients with BPPV and forty-eight healthy controls were included in the study. ECG was performed on all participants, and ECG parameters were measured. Holter monitoring was performed, and the recordings were analyzed. Evaluation of the time-domain heart rate variability (HRV) results was done. RESULTS: The average age of the vertigo group was 49.1 ± 7.8 years. In terms of demographic or laboratory data, there was no statistically significant difference between the groups (p>0.05). The study group's ECG parameters, including Pd, TpTe, and TpTec, were longer, and the TpTe/QT and TpTe/QTc ratios were higher (p<0.05). Holter monitoring detected abnormal rhythms in 41 (63%) of the study group patients and three (6.2%) of the control group patients. The SDNN, LF, and LF/HF values, which are known as HRV markers, were significantly different in the vertigo group compared to the control group (p<0.001). CONCLUSIONS: This study revealed that the risk of arrhythmias increased following attacks of BPPV in patients without a known history of cardiac vertigo.

Factors associated with all-cause mortality in patients with coronary artery chronic total occlusions undergoing revascularization (percutaneous coronary intervention or surgery) or medical treatment.

Aim    Chronic total occlusion of a coronary artery (CTO) is a predictor of early and late cardiovascular mortality and poor cardiovascular outcomes in patients with coronary artery disease. The purpose of this study was to identify predictors of all-cause mortality in CTO patients that underwent invasive treatment.Material and methods    Patients between 2012 and 2018 with CTO in at least one vessel, as demonstrated by coronary angiography, were included retrospectively in the study. The patients were divided into two groups, an intervention group (percutaneous and surgical revascularization) and a medical group.Results    A total of 543 patients were studied, 152 females (28%) and 391 males (72%). The median follow-up period was 49 (26-72) mos. A total of 186 (34.2%) patients in the medical group and 357 (65.8%) patients in the invasive therapy group were followed. The 5-yr death rate was observed in 50 (26.9%) patients in the medical group and 53 (14.8%) patients in the intervention group, and it was found to be statistically higher in the medical group (p=0.001). In multivariable analysis, heart failure (odds ratio (OR): 1.92, 95% CI: 1.18-3.14; p=0.01), higher glucose levels (OR: 1.05, 95% CI: 1,02-1.08; p=0.04), lower albumin levels (OR: 0.49, 95% Cl: 0.32-0.72; p=0.001), SYNTAX score (OR: 1.03, 95% CI: 1.01-1.05; p=0.001), and CTO (≥2 occluded artery) (OR: 0.42, 95% CI: 0.22-0.72; p=0.01) were independent factors for all-cause mortality.Conclusion    In comparison to the revascularized group, there was an increase in mortality among CTO patients treated medically. Heart failure, SYNTAX score, albumin, glucose, and CTO (≥2 occluded arteries) were independent risk factors for all-cause mortality.

Cardiac arrhythmias, conduction system abnormalities, and autonomic tone in patients with brucellosis.

OBJECTIVE: Arrhythmias can occur because of cardiac involvement in patients with brucellosis. We investigated the effect of Brucella (Brucella melitensis) on cardiac arrhythmias in patients without pre-existing arrhythmogenic heart disease. PATIENTS AND METHODS: 205 patients with sinus rhythm who were diagnosed with brucellosis and 205 healthy controls were enrolled. ECG was performed, and the parameters were recorded for each patient. 24-hour ambulatory ECG (Holter) monitoring was conducted, and the recordings were analyzed. The time-domain heart rate variability (HRV) results were evaluated. RESULTS: The average age of the group with brucellosis was 28.9±6.4 years, and 57.1% were male. The ECG parameters, including P dispersion (Pd), QT dispersion (QTd), corrected QTd (QTcd), T-peak to T-end (TpTe), and corrected TpTe (TpTec) were longer and TpTe/QT, TpTe/QTc, TpTec/QT, and TpTec/QTc ratios were higher in the study group compared to the control group (p<0.05). Holter monitoring recorded 33 (16.1%) patients in the study group and 3 (3%) in the control group with abnormal rhythms. In the brucellosis group, low frequency (LF), low/high frequency (LF/HF), and the standard deviation of all R-R intervals (SDNN) values, which are known HRV indicators, were substantially different than in the control group (p<0.001). CONCLUSIONS: We can evaluate the silent involvement of the cardiac conduction system in patients with brucellosis using ECG parameters, which is a non-invasive and simple method in terms of feasibility in clinical follow-up.

Evaluation of the relationship between appearances of the lingual foramen on panoramic radiography and cone-beam computed tomography.

AIM: The aim of this retrospective study is to determine the level of visibility of the lingual foramen in panoramic radiography using cone-beam computed tomography (CBCT) as a reference tool. METHOD: A total of 200 patients (111 females and 89 males) were included in the study. Cross-sectional CBCT images of the mandible in the midline were used to locate and define the orifice and diameter of each lingual canal that was detected. The appearance of the lingual foramen in the anterior mandible in panoramic radiography was assessed using a five-point ordinal scale. Descriptive statistics including tables and graphs were used. The correlation between CBCT and panoramic radiography findings were analyzed using Chi-square tests. RESULTS: The lingual foramen was found to be located most frequently in the mandibular midline, above the genial tubercle (78.5%). A narrow-diameter type was found to occur most frequently (56.5%). A prominent genial tubercle was the most commonly found type (57.5%). The lingual foramen could be definitively identified in panoramic radiographs in only 8 cases (4%), while a high degree of probability was found in 25 cases (12.5%). The lingual foramen appears wider and therefore more distinctive in panoramic radiographs when the angulation of the lingual canal is less than 20° to the ground plane. CONCLUSIONS: Radiological evaluation with panoramic radiographs alone may lead to inadequate assessments prior to surgical procedures involving the anterior mandible. Clinicians may consider using three-dimensional imaging for procedures with a risk of hemorrhagic and neurosensory complications such as dental implant placement in the anterior mandible.

Cone beam computed tomography evaluation of variations in the sella turcica in a Turkish population.

BACKGROUND: The aim of the study was to analyse the variations of the sella turcica and their relationship to age and gender. MATERIALS AND METHODS: The cone beam computed tomography (CBCT) images of the patients who referred to Gaziantep University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology were analysed by two examiners and 200 CBCT images were evaluated retrospectively. Sella turcica shapes of individuals were described according to Axelsson's classification as either normal or with aberrations including: oblique anterior wall, double contour of the floor, sella turcica bridging, irregularity in the posterior part of the dorsum sella, and pyramidal shape of the dorsum sella. RESULTS: Normal sella turcica was the most common type seen in 100 (49.8%) individuals. The secondary common type was double contour of the floor of sella turcica seen in 46 (22.9%) patients. Thirty-two (15.9%) patients had oblique anterior wall. Seventeen (8.5%) individuals had pyramidal shape of the dorsum sella, 3% irregularity in the posterior part of the sella turcica. None of the patients had sella turcica bridging. Irregularity in the posterior part of the sella turcica and pyramidal shape of the dorsum sella were reported significantly more frequent in female than male. CONCLUSIONS: Sella turcica varies in shape and morphology regardless of age. Normal sella turcica was the most frequent type in the study group. Irregularity in the posterior part of the sella turcica and pyramidal shape of the dorsum sella were reported more frequent in female than male.

Anatomical evaluation of nasopalatine canal on cone beam computed tomography images.

BACKGROUND: Nasopalatine canal (NPC) (incisive canal) morphology is important for oral surgery techniques carried out on the maxilla, in the treatment of naso- palatine cyst, palatal pathologies that require a surgical intervention. MATERIALS AND METHODS: The morphology of NPC was classified in sagittal, coronal and axial planes on the cone beam computed tomography (CBCT). The length of NPC was found by measuring the distance between the mid-points of nasopalatine foramen and incisive foramen. The numbers, shapes and diameters of incisive and nasopalatine foramina were examined. Nasopalatine angle present between the NPC and the palate and anterior to the NPC was measured. RESULTS: In the sagittal plane, the shape of NPC was classified in six groups: 26.7% hourglass, 14.7% cone, 13.3% funnel, 16.0% banana, 28.7% cylindrical and 0.7% reverse-cone-shaped. In the coronal plane, shape of NPC was classified in three groups: 63.3% Y-shaped, 36.0% single canal, 0.7% double canal and external border of NPC was classified in four groups: 26.7% U, 28.7% Y, 44.0% V and 0.7% reverse-V-shaped. In the axial plane, the shape of nasopalatine foramen, incisive foramen and NPC at the mid-level was evaluated. The shape of the canal was detected as four types at three evaluated levels: round, oval, heart- and triangle-shaped. It was seen in every three axial planes that the round group is more than the others. CONCLUSIONS: The morphological properties and variations of NPC should be con- sidered with a correct radiological evaluation so as to prevent the complications and improper practices in local anaesthesia, maxillary surgery and implant surgery practices. Especially dentists, otolaryngologist and plastic surgeons need to know the anatomy and variations of NPC.

Impact of The Method of Diagnosis on The Stage of Breast Carcinoma.

OBJECTIVE: Screening mammography is recommended to women at a certain age to achieve an early diagnosis. The purpose of this study is to find out how breast carcinoma was diagnosed and the impact of the method of diagnosis on the stage of the tumor. MATERIALS AND METHODS: In this study, 903 operated breast cancer patients, between 2010-2016, in a large volume Marmara University Istanbul Pendik Education and Research Hospital were analyzed retrospectively. Patients presenting with clinical symptoms and those diagnosed with screening were investigated separately. The percentage of the patients diagnosed with symptoms and the impact of the method of diagnosis on the stage of the tumor was the primary outcome of the study. RESULTS: 738 patients fulfilling inclusion criteria with complete clinical records were analyzed. 126 patients (17%) were in the age range of 19-39 years, while 32% (236 patients) were 40-50 and 51% (376 patients) were older than 50 years.485 patients (65.7%) were diagnosed with a mass in the breast, while 241 (32.6%) patients were diagnosed with screening with mammography. Twelve patients (1.7%) presented with nipple discharge. Median tumor sizes measured in the resected specimen were 22 mm, 21 mm, and 21 mm in patients diagnosed with a mass, screening, and nipple discharge respectively. The difference among the groups were not significant (p=0.460).Axillary lymph nodes were positive in 210 (43.3%) of patients presenting with a mass in the breast while 85 patients (35.3%) diagnosed with screening had metastatic lymph nodes in the axilla. Three patients presenting with nipple discharge had positive axillary lymph nodes (p=0.137). CONCLUSION: This study demonstrated that breast cancer screening programs in Turkey needs improvement and at the same time shows that screening with mammography after 40 years of age should be done annually despite Ministry of Health recommendations.

Multiple tooth anomalies in a nonsyndromic patient with class II division 2 malocclusions: A case report and a literature review.

Reports in the literature about the craniofacial characteristics of patients with class II division 2 malocclusions show a lot of different patterns accompanied by palatally displaced upper incisors, congenital missing teeth, polydiastema, fusion, germination, tooth impaction, peg-shaped lateral incisors, persistent teeth, hypodontia, persistent deciduous teeth, transpositions, and supernumerary teeth. The following case report focuses on the description of the clinical characteristics observed on a patient with a very unusual conjunction of dental and skeletal anomalies mentioned above, as well as a literature review on the related issues. Extra-intra-oral examinations, radiographic evaluations, orthodontic consultation, and reviewing the literature concluded that this nonsyndromic patient that refused to receive all dental treatment approaches is special with its uniqueness.

Location of the appendix at the third trimester of pregnancy: A new approach to old dilemma.

The aim of this study was to determine the location of the appendix at the third trimester of pregnancy as there are conflicting results in literature. Distances from the base of the appendix were measured intra-operatively to the anterior iliac spine (A), symphysis pubis (B) and the xyphoid process (C). The same measurements were taken from McBurney's point on the abdominal wall (A1, B1 and C1). In the allocated 21 pregnant and 18 non-pregnant women, distance A and B were 10.3 ± 0.9 cm and 18.3 ± 3.2 cm in pregnant and 6.7 ± 0.9 cm and 13.2 ± 0.9 cm in non-pregnant women (p < 0.001), respectively. Distance C was shorter in pregnant women (14.7 ± 2.5 cm vs. 23.8 ± 1.9, p < 0.001). Conversely, distance C1 was longer in pregnant women (30.3 ± 3.0 vs. 24.8 ± 5.1 cm, p = 0.004). This study provides evidence that the appendix moves cranially late in the course of the pregnancy. Therefore, McBurney's point cannot be used as a reference point to localise the appendix at the third trimester of pregnancy.

Retained abdominal gallstones after laparoscopic cholecystectomy: a systematic review.

AIM: The aim of this study is to make a systematic review of high-quality published trails regarding the complications of retained gallstones after laparoscopic cholecystectomy for cholelitiasis. MATERIALS AND METHODS: Medline search from 1987 to 2013 was done. Nine studies with >500 LCs which reported retained gallstones and perforated gallbladders were analyzed systematically. RESULTS: Of 536 listed reports including case reports, clinical trials, reviews, journal articles, and meta-analytic reports; 9 studies each reporting >500 LCs which reported the incidence of perforated gallbladders and spilled stones were found. The number of operations, the number of perforated gallbladders, the number of patients who had gallstone spillage, and the postoperative complications were searched in these studies and the strongest and weakest aspects of the articles were discussed. CONCLUSIONS: Retained abdominal gallstones can cause various postoperative problems including extra-abdominal complications. In case of perforation of the gallbladder during laparoscopic cholecystectomy, spilled gallstones should be collected to prevent further complications but conversion to open surgery is not mandatory.

Evaluation of radiographic features of embedded primary molar roots in adult Turkish population.

BACKGROUND: The roots of primary molars were found in the permanent dentition without symptoms on the clinical or radiographic examination. However, their incidence could not be achieved on the current literature. OBJECTIVE: The aim of this study is to evaluate the radiographic features of the embedded primary molar roots in adult dentulous patients in Turkey. MATERIALS AND METHODS: The data, from 5000 adult patients, including panoramic radiographs and demographic information, were evaluated retrospectively. The prevalence and location of the primary molar roots in the jaws were determined, as well as the prevalence and location of the primary molar roots in the adjacent permanent root levels. RESULTS: Among 5000 Turkish population dentulous patients, 20 retained primary molar roots (0.38%) were found in 19 ones. CONCLUSIONS: The prevalence of the primary molar roots in the present study was found to be lower than that of the previous study. This finding may result from the larger amount of patient data that was evaluated in this study, which used panoramic radiographs.

Surgeon behavior and knowledge on hand scrub and skin antisepsis in the operating room.

BACKGROUND: Surgical site infections adversely affect patients' well-being. In this study, hand-washing details and adherence to surgical site antisepsis applications among surgical staff were observed and recorded. Then, a questionnaire was given to test surgeons' theoretical knowledge on operating room principles. METHODS: Staffs from 5 surgical units were selected (surgeons and nurses from general surgery, urology, plastic surgery, thoracic surgery, and gynecology and obstetrics) and observed. They were questioned on the choice and properties of antiseptics, proper duration of hand washing and use of brushes, and essentials of patient skin antisepsis. RESULTS: A total of 107 observations (53 residents, 27 nurses, 6 attending staff, and 21 academic staff) were done. Overall mean (± standard deviation) hand-washing time was 69.1 (49.8) seconds (range: 43.8-98; p: 0.001). Overall, 79 (73.8%) never used a brush, 18 (16.8%) used the brush for the nails only, and 10 (9.4) used the brush for hands and arms as well as the nails. Mean (± standard deviation) time from the application of skin antiseptic to surgical incision time was 6.7 (3.5) minutes (p: 0.088). According to the questionnaire, surgeons believed that proper hand-washing time should be 4.2 ± 2.8 minutes (p = 0.13). Brush usage was questioned and 50 (70.4%) favored brush usage whereas 21 (29.6%) were against it. The question for mechanism of action of povidone iodine is answered as 'bactericidal' by only 69%. CONCLUSION: The study shows that both adherence to local hand-hygiene protocols and surgical staffs' basic knowledge about surgical antisepsis are low.

Gallstones and Concomitant Gastric Helicobacter pylori Infection.

Background. The association of gallstones with Helicobacter pylori has been investigated but not clearly demonstrated. In this study, the presence of H. pylori in the gallbladder mucosa of patients with symptomatic gallstones was investigated. Method. Ninety-four consecutive patients with symptomatic gallstone disease were enrolled for the study. Gastroscopy and gastric H. pylori urease test were done before cholecystectomy to all patients who accepted. After cholecystectomy, the gallbladder tissue was investigated in terms of H. pylori by urease test, Giemsa, and immunohistochemical stain. Results. Overall 35 patients (37%) gallbladder mucosa tested positive for H. pylori with any of the three tests. Correlation of the three tests Giemsa, IHC, and rapid urease test was significant (r s : 0590, P > 0.001). Rapid urease test was positive in the gastric mucosa in 47 (58.7%) patients, and it was positive in the gallbladder mucosa in 21 patients (22%). In 15 patients both gastric and gallbladder tested positive with the urease test. There was significant correlation of rapid urease test in both of gallbladder and gastric mucosa (P = 0.0001). Conclusion. Study demonstrates the presence of H. pylori in the gallbladders of 37% of patients with symptomatic gallstones.

Whey protein versus whey protein hydrolyzate for the protection of azoxymethane and dextran sodium sulfate induced colonic tumors in rats.

Recent studies have shown that whey protein has many useful effects including its anti-cancer effect. In this study we have compared the protective effect of dietary whey protein with whey protein hydrolyzate against azoxymethane and dextran sodium sulfate induced colon cancer in rats. We used a rat model of the colon cancer induced by administration of azoxymethane followed by repeated dextran sodium sulfate ingestion which causes multiple tumor development. Colon tissues were analyzed histologically in addition to biochemical analyses performed by measuring lipid peroxidation, protein oxidation and glutathione levels in both of colon and liver tissues of rats after sacrification. Macroscopic and microscopic tumors were identified in all groups that received azoxymethane followed by repeated dextran sodium sulfate. Group fed with whey protein hydrolyzate showed significantly less macroscopic and microscopic tumor development compared with group fed with whey protein. The protocol applied to generate an appropriate model of colon cancer was successful. Whey protein hydrolyzate was found to be more effective in preventing colon tumor development compared with whey protein.

The prevalence of pulp stones in a Turkish population. A radiographic survey.

OBJECTIVES: The goal of this retrospective study was to determine the prevalence of pulp stones in a Turkish population. Any possible associations between pulp stones and gender, tooth type and dental arch were also evaluated. STUDY DESIGN: Four hundred and sixty nine patients' bitewing radiographs which were reached through the patient database of Erciyes University Dentistry School, Department of Oral Diagnosis and Radiology were examined. Of these 469 subjects whose mean age was 24( ± 10.7), 302 were females and 167 were males. A total of 6,926 teeth were examined during this study. Pulp stones were recorded as present or absent and any relations with gender, tooth type and dental arch were noted. RESULTS: Pulp stones were identified in 270 (57.6 %) of the subjects and in 1,038 (15 %) of the teeth examined. Their presence were seldom found in the premolars (9.07%) but was much higher in the molars (90.92 %). Pulp stone occurrence was significantly more common in the first molars than in the second molars, and in the first premolars than in the second premolars in each dental arch. Their occurrence was higher in the maxilla than in the mandible for each tooth type. No difference between the two genders could be identified. CONCLUSION: Pulp stones are not only incidental radiographic findings of the pulp tissue but may also be an indicator of some serious underlying disease. On the other hand, they may provide useful information to predict about the susceptibility of patients for other dystrophic soft tissue calcifications such as urinary calculi and calcified atheromas. However, further study on this issue is needed.

Dietary whey supplementation in experimental models of wound healing.

Whey is a dairy product containing milk serum proteins with diverse biological effects. In this study, the effect of dietary whey supplementation on wound healing was investigated. Rats were fed a standard or whey-supplemented diet for three weeks. Wound healing parameters, glutathione, and lipid peroxide levels were determined three days after the application of two different models of wound healing, i.e. laparotomy and colonic anastomosis. Dietary whey supplementation significantly increased glutathione levels and suppressed lipid peroxidation after experimental laparotomy and colonic anastomosis. Bursting pressures, hydroxyproline, and cytokine levels were not changed. Our results show that dietary whey supplementation increases glutathione synthesis and cellular antioxidant defense. Long-term effects of whey feeding on wound healing remains to be investigated.

Enterostomy closure site hernias: a clinical and ultrasonographic evaluation.

BACKGROUND: Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to find the true incidence of ostomy closure site and laparotomy incisional hernias. METHODS: We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. RESULTS: The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a significant effect on hernia formation. CONCLUSION: Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.

Enterostomy site hernias: a clinical and computerized tomographic evaluation.

PURPOSE: Parastomal hernia continues to be an important clinical problem with a reported incidence of up to 50 percent. In studies using computerized tomography in selected cases for detection of parastomal hernia, physical examination alone was underestimating the true incidence. Also after closure of the enterostomy, the ostomy site could still be a potential area of herniation. In this study in addition to physical examination, we used computerized tomography to determine the true incidence of parastomal hernia and ostomy closure site hernias. METHODS: We examined patients with enterostomies and with closed enterostomy sites both with physical examination and computerized tomography for the detection of hernias, hernia content, and relation to rectus muscles. Risk factors for hernia formation, such as age, gender, body mass index, associated medical problems, and surgical site infections, were determined. RESULTS: Evaluation of 23 patients with ostomies resulted in 52 percent incidence of parastomal hernia, whereas the addition of tomography examination gave a corrected incidence of 78 percent. In a second subset of 23 patients with closed ostomies, although 26 percent of the patients were found to have ostomy site hernias with physical examination alone, this incidence increased to 48 percent when combined with computerized tomography. The potential risk factors for hernia formation, such as body mass index, surgical site infection, and ostomy site whether pararectus or transrectus, were not proven to have a significant role in this study. CONCLUSIONS: Parastomal hernia and closed ostomy site incisional hernias have a high incidence, and computerized tomography has been shown to be a valuable diagnostic tool.