Residual Gastric Volume Relationship and Weight Loss After Laparoscopic Sleeve Gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become a popular procedure for treating obesity. Excessive residual gastric volume (RGV) may be one cause of insufficient weight loss following this surgery. The purpose of this study was to investigate the relationship between weight loss and the RGV measured during surgery over a 2-year follow-up period. METHODS: All patients undergoing LSG at our university surgery department were included in this prospective observational study. During the operation, the pylorus was grasped with a laparoscopic clamp, and saline solution dyed with methylene blue was introduced using an intraluminal glass-tipped injector when the residual stomach became fully visible. The amount of fluid given when the remaining gastric tissue ceased expanding was noted. The patients were divided into three groups depending on the volume of the residual gastric tissue. Percentages of excess weight loss (EWL%) were also evaluated 6, 12, and 24 months after the LSG. RESULTS: Sixty-two patients (50 females and 12 males) with a mean age of 36 (17-56) years were included in the study. There was no significant difference between the preoperative and postoperative body mass index values (p = 0.407 and p = 0.337, respectively) or between the preoperative and postoperative weight (p = 0.081 and p = 0.517, respectively) among the groups. A comparison of the participants' weight losses and EWL% values after 6, 12, and 24 months of follow-up revealed no significant difference among the groups at any time point (p > 0.005). CONCLUSION: Greater weight loss was observed as the RGV decreased over the 24-month follow-up period. However, that weight loss was not statistically significant.

Relation between radiographic BI-RADS scores and triple negativity in patients with ductal carcinomas.

UNLABELLED: The aim of this study was to investigate association of radiographic (BI-RADS 4 and 5) results and prognostic factors of invasive ductal carcinomas with their histopathological subtypes. A total of 103 patients histopathologically diagnosed with invasive ductal carcinoma of breast with in last five years period were enrolled. Of them, 69 patients who had radiological reports in were included from registry of Radiology Department; Duzce University Training and Research Hospital archives. BI-RADS scores (4 and 5) of radiological reports and subtypes of ductal carcinoma were compared. Of 69 cases, 12 of 22 cases with BIRADS 4 score were Triple negative (TN) while 5 of 47 cases with BIRADS 5 score were TN (p = 0.001). The patients with TN tumors were found to have lower average age, higher grade, higher Ki67 proliferative index and fewer lymph node metastasis than those with non-TN ductal carcinomas (p = 0.048; 0.019; 0.02; 0.048 respectively). CONCLUSIONS: Patients who had radiological BIRADS 4 score were significantly more frequent TN type carcinoma than BI-RADS 5. It is important to pay attention to this issue when clinicians evaluate patients with BI-RADS 4 score breast lesions.

Effects of cruroraphy and laparoscopic Nissen fundoplication procedures on pulmonary function tests in gastroesophageal reflux patients.

Gastroesophageal reflux disease plays a role in the etiology of asthma, chronic bronchitis, aspiration pneumonia, bronchiectasis and interstitial lung fibrosis by affecting the upper respiratory system. To investigate the changes in pulmonary function tests in patients who underwent cruroraphy and laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Between January and October of 2012, cruroraphy and laparoscopic Nissen fundoplication have been carried out on 40 patients with gastroesophageal reflux disease in the Department of General Surgery, Faculty of Medicine, Duzce University. Patients had pulmonary function tests were measured preoperatively and on postoperative day 20. Increases in forced vital capacity, forced expiratory volume in 1 second/forced vital capacity and forced expiratory flow between 25-75% of vital capacity were observed postoperatively in all patients and these increases were found to be statistically significant (p=0.001). Change in the forced expiratory volume in 1 second was not statistically significant (p=0.182). We conclude that treatment of reflux in early stages by surgical procedures could prevent development of chronic lung disease by safeguarding the pulmonary system functions.

Malrotation-associated cholecystoduodenal fistula.

PATIENT: Female, 16 FINAL DIAGNOSIS: Malrotation and cholecystoduodenal fistula Symptoms: Abdominal pain • anorexia • fever • nausea • vomiting MEDICATION: - Clinical Procedure: - Specialty: Gastroenterology and Hepatology. OBJECTIVE: Anatomical anomaly/variation. BACKGROUND: Cholecystoduodenal fistula (CDF) is the most common cholecystenteric fistula. It is a late complication of gallbladder disease with calculus and is mainly encountered in the elderly and females. CASE REPORT: We report the case of a teenage patient with cholecystoduodenal fistula and malrotation. Direct plain abdominal x-ray demonstrated air in the biliary system. Computed tomography revealed CDF-associated with an anomaly of intestinal malrotation. She had gallstones (with a few stones in the gallbladder) and cholecystitis. CDF is caused by malrotation, and cholecystitis has not been reported before. In this regard our patient is the first and youngest reported case. CONCLUSIONS: We suggest that CDF is probably a consequence of malrotation. The patient's clinical features and operative management are presented and discussed with current literature.

The hemostatic effect of calcium alginate in experimental splenic injury model.

BACKGROUND: We evaluated the effect of calcium alginate as a hemostatic agent in a splenic injury model. METHODS: Experimental rats (Wistar albino) were divided into four groups. Group I: Laparotomy was not performed. Group II: After laparotomy, the abdomen was closed without any splenic injury. Group III: After laparotomy, splenic injury about 0.5 cm in depth and 0.3 cm in length was created by standard Rochester pean forceps. Physiological serum treated gauze dressing, about 2x2 cm in size, was applied to the injured splenic tissue for 3 minutes. Group IV: After laparotomy, standard splenic injury about 0.5 cm in length and 0.3 cm in depth was created. Calcium alginate wound dressing, 1x1 cm in size, was applied to the splenic wound. In all groups, blood samples for bleeding time and hemogram were taken. Peroperative blood loss, pre- and post-operative hemoglobin and hematocrit values were calculated. RESULTS: Comparing hematocrit values and peroperative bleeding in Groups III and IV, Group IV had a lower decline in hematocrit values and lower peroperative bleeding. CONCLUSION: Calcium alginate has hemostatic capacity. It may be used in splenic injuries, especially for Grades I and II.

The early anti-inflammatory effect of Kefir in experimental corrosive esophagitis.

AIM: Corrosive esophageal burns are still an important problem. The aim of this study was to evaluate the effect of kefir in an experimental corrosive esophagitis model. MATERIAL AND METHOD: Twenty-four male wistar albino rats were used in this experimental study. The rats were randomized into three groups according to the procedure and treatment type (each group has eight rats). Group I: (Control group), Group II: (Induction of corrosive esophagitis with 5 % NaOH without any treatment) and Group III: (Corrosive esophagitis treated with kefir). The rats were sacrificed on the first and seventh days. Mediastinum and abdominal cavity of rats were explorated. Approximately 1.5 cm of esophagus was removed for histopathological examination. Inflammation, injury in the muscularis mucosa and collagen deposition were evaluated. RESULTS: Histopathological results on the first day after caustic injury; inflammation was detected in three rats in Group II and there were no inflammation in rats in Group III. This difference was statistically significant (p<0.05). Injury in muscularis mucosa was detected in three rats in Group II and in one rat in Group III. Histopathological results on the seventh days after caustic injury; Inflammation was positive in four rats in Group II and three rats in Group III. Injury in muscularis mucosa was equal in two groups (three rats each). Collagen deposition with high grade (Grade 2) was detected in two rats in Group II and in four rats in Group III (p<0.05). CONCLUSION: Kefir has anti-inflammatory effect specially in early phase of caustic injury. It has also some beneficial effect in wound healing.

[Investigation of the effects of probiotic bacteria on bacterial translocation that developed during diagnostic laparoscopy: an experimental study]. / Tanisal Amaçla Uygulanan Laparoskopi Sirasinda Olusan Bakteriyel Translokasyona Probiyotik Bakterilerin Etkilerinin Arastirilmasi: Deneysel Bir Çalisma.

Probiotics which are non-pathogenic live microorganisms ingested along with food or as dietary supplements, are thought to be beneficial to the host by supporting the microbial balance in digestive system. Various studies suggest that the effects of probiotics on the intestinal mucosa and immunity are protective against bacterial translocation. We aimed to investigate bacterial translocation related to the amount of CO2 insufflation given during laparoscopy and the effect of probiotic bacteria in an experimental peritonitis model. In this study 60 Wistar rats were used in six groups consisting of 10 rats. Group 1, 3 and 5 consisted of the rats that were fed without probiotics, while the rats in Group 2, 4, and 6 were fed with water containing 5 x 108 cfu/ml probiotic bacteria complex (Bifidobacterium lactis, Lactobacillus bulgaricus, Streptococcus thermophilus) for 15 days. To generate experimental peritonitis, 2 x 107 cfu/ml Escherichia coli ATCC 25922 was inoculated intraperitoneally to all of the rats. Thereafter, laparoscopy was applied in all groups. Application in Group 1 and Group 2 was without CO2; Group 3 and Group 4 with 14 mmHg CO2 insufflation, and Group 5 and Group 6 with 20 mmHg CO2 insufflation. Blood samples were taken in 2nd, 4th, and 6th hours. Mesenteric lymph node, liver and spleen samples were taken at 6th hour when the rats were sacrificed and then these were evaluated microbiologically with qualitative and quantitative methods. Bacterial translocation and bacteremia were found in the rats that were undergone experimental peritonitis during laparoscopy. All positive tissue and blood cultures yielded E.coli. The highest level of bacterial translocation was found to be in mesenteric lymph nodes (in 3/10, 6/10 and 10/10 in groups 1, 3 and 5 fed without probiotics, respectively; in 2/10, 3/10 and 4/10 in groups 2, 4 and 6 fed with probiotics, respectively). The bacterial translocation rates were found to be related to the increased CO2 insufflation. It was found that probiotic bacteria were more effective for decreasing bacterial translocation rates and bacteremia in the groups that were given high CO2 pressure during laparoscopy. It was also found that these results were correlated with bacterial translocation per gram of tissue. As an example, the quantitative bacterial growth values detected in mesenteric lymph node were 5.4 ± 2.9 x 103, 10.6 ± 3.3 x 103 and 21.5 ± 12.4 x 103 cfu/g in groups 1, 3 and 5, fed without probiotics, respectively; and 2.0 ± 1.3 x 103, 3.8 ± 1.9 x 103 and 9.0 ± 3.1 x 103 cfu/g in groups 2, 4 and 6, fed with probiotics, respectively. Our data emphasized that probiotic bacteria may be used as prophylactic agents for the prevention of bacterial translocation during laparoscopy, however comprehensive and clinical studies are needed to support these experimental results.

Intussusception of the appendix induced by sessile serrated adenoma: a case report.

Intussusception of the appendix vermiformis is a rare condition. It occurs mainly in infants and children. Here, we report an intussusception case that occurred in a 65-year-old male presenting with repeated periumbilical pain, nausea, vomiting and febrile sensation. The appendix was seen to be intussuscepted at laparoscopy. The invaginated segment was reducted and simple appendicectomy was carried out. Histopathologic examination revealed a sessile serrated adenoma at the wall of the appendix, suggesting it as the cause of the intussusception.

The evaluation of Pat-Pat related injuries in the Western Black Sea region of Turkey.

BACKGROUND: Accidents caused by motorized vehicle in the agricultural sector are frequently observed. In Turkey; accidents arising from motorized vehicles, named Pat-Pat, which are used by farmers in the Western Black Sea region is not unusual. METHODS: One hundred five patients who were brought into the Emergency Department of Duzce University, Medical Faculty Hospital between September 2009 and August 2010 due to Pat-Pat related accidents were evaluated. RESULTS: The cases consisted of 73 (69.5%) males and 32 (30.5%) females, ranging from 2 to 73 years of age. In the 10-39 age group, a total of 63 (60.0%) cases were determined. The months when the greatest rate of cases applied to the hospital consisted of July, August, September and the season is summer. The cases were exposed to trauma in roads in 54 (51.4%), and 51 (48.6%) occurred in agricultural area without roads. Eighty seven (82.9%) cases were injured due to the overturning of vehicle. The patients were brought to the hospital using a private vehicle in 54 (51.4%) of the cases and in 51 (48.6%) cases, 112 ambulance system was used. The cases were determined to apply to the hospital most frequently between 6 pm-12 am. The injuries frequently consisted of head-neck and spine traumas, thorax traumas and upper extremity traumas. In 55 (52.4%) cases, open wound-laceration was determined. Seventy five (71.4%) cases were treated in the Emergency Department, and 28 (26.7%) were hospitalized. Three (2.9%) cases were deceased. CONCLUSIONS: Serious injuries can occur in Pat-Pat related accidents, and careful systematic physical examination should be conducted. In order to prevent these accidents, education of farm operators and engineering studies on the mechanics and safety of these vehicles should be taken and legal regulations should be created.

Primary echinococcus cyst of the thyroid: a case report.

Echinococcosis, although eradicated in many countries, is still widespread in communities where agriculture is dominant. Cystic hydatidosis is a significant public health problem in the regions with endemic echinococcosis. The hydatid cysts tend to form in the liver or lung, but may also be found in other organs of the body such as brain, heart, and bone, while thyroid gland involvement is rather rare. A 25 year old male presented with solitaire goiter. Laboratory tests and thyroid profile proved normal. Surgical exploration revealed hydatid cyst in the left lobe of the thyroid gland. Examination of the nodule showed it to be a solitary primary thyroid hydatid cyst.

Prevention of pulmonary complications of pneumoperitoneum in rats.

BACKGROUND: Carbon dioxide (CO2) pneumoperitoneum facilitates the visualization of abdominal organs during laparoscopic surgery. However, the associated increase in intra-abdominal pressure causes oxidative stress, which contributes to tissue injury. OBJECTIVE: We investigated the ability of the antioxidant and anti-inflammatory drug Erdosteine to prevent CO2 pneumoperitoneum-induced oxidative stress and inflammatory reactions in a rat model. METHODS: Fourteen female adult Wistar albino rats were divided into a control group (Group A, n = 7) and an Erdosteine group (Group B, n = 7). Group A received 0.5 cc/day 0.9% NaCl, and Group B received 10 mg/kg/day Erdosteine was administered by gavage, and maintained for 7 days prior to the operation. During the surgical procedure, the rats were exposed to CO2 pneumoperitoneum with an intra-abdominal pressure of 15 mmHg for 30 min. The peritoneal gas was then desufflated. The rats were sacrificed following 3 h of insufflation. Their lungs were removed, histologically evaluated, and scored for intra-alveolar hemorrhage, alveolar edema, congestion, and leukocyte infiltration. The results were statistically analyzed. A value of P < 0.05 was considered statistically significant. RESULTS: Significant differences were detected in intra-alveolar hemorrhage (P < 0.05), congestion (P < 0.001), and leukocyte infiltration (P < 0.001) in Group A compared with Group B. However, the differences in alveolar edema were not statistically significant (P = 0.698). CONCLUSIONS: CO2 pneumoperitoneum results in oxidative injury to lung tissue, and administration of Erdosteine reduces the severity of pathological changes. Therefore, Erdosteine may be a useful preventive and therapeutic agent for CO2 pneumoperitoneum-induced oxidative stress in laparoscopic surgery.

Acute calculous cholecystitis caused by Candida lusitaniae: an unusual causative organism in a patient without underlying malignancy.

Candidiasis of the gallbladder is an uncommon cause of acute cholecystitis. Candidal cholecystitis is seen especially in patients with malignancies. In the present case, we report that acute calculous cholecystitis was caused by Candida lusitaniae in a 33-year-old patient without underlying malignancy. According to our review of the literature, this is the first report of acute cholecystitis caused by C. lusitaniae.

[Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis: experimental study]. / Erken enteral ve glutaminli enteral beslenmenin kolon anastomoz iyilesmesine etkisi: Deneysel çalisma.

BACKGROUND: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH(2)O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH(2)O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH(2)O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 microg) was significantly higher than late TEN group (1509.6 microg; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 microg). CONCLUSION: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.