Parentage verification and genetic diversity of the Arabian and Thoroughbred horse populations in Türkiye using microsatellite analysis.

INTRODUCTION: This study aimed to determine the effectiveness of parentage verification in Arabian and Thoroughbred horses in Türkiye using microsatellite markers. A total of 813 Arabian and 959 Thoroughbred horses were genotyped using a total of 17 microsatellite markers. The mean effective number of alleles was 3,34 and the mean number of alleles was 7,41 in Arabian horses. It was calculated that the mean He and Ho values in Arabian horses were 0,677 and 0,680, respectively. The mean effective number of alleles was 3,55 and the mean number of alleles was 6,59 in Thoroughbred horses. It was calculated that the mean Ho and He values in Thoroughbred horses were 0,697 and 0,684, respectively. When the studied Arabian and Thoroughbred horse populations are considered as a single population, the mean FIT, FST and FIS values were found to be 0,063, 0,074 and, - 0,011, respectively. Also, 4 loci in Arabian horses and 3 loci in Thoroughbred horses significantly deviated from HWE. The mean PIC value was 0,63 in Arabian horses and 0,64 in Thoroughbred horses. As a result; the microsatellites including the most informative 15 and 9 loci had a total value of > 0,9999 (11 and 7 loci > 0,999) in each population for PE - 1 and PE - 3, respectively. It has been concluded that parentage verification and genetic identification can be made successfully in the Arabian and Thoroughbred horse populations by using the microsatellite markers panel.

INTRODUCTION: Cette étude visait à déterminer l'efficacité de la vérification de la parenté chez les chevaux arabes et pur-sang de Turquie à l'aide de marqueurs microsatellites. Au total, 813 chevaux arabes et 959 chevaux pur-sang ont été génotypés à l'aide de 17 marqueurs microsatellites. Le nombre effectif moyen d'allèles était de 3,34 et le nombre moyen d'allèles était de 7,41 chez les chevaux arabes. Il a été calculé que les valeurs He et Ho moyennes chez les chevaux arabes étaient respectivement de 0,677 et 0,680. Le nombre effectif moyen d'allèles était de 3,55 et le nombre moyen d'allèles était de 6,59 chez les chevaux pur-sang. On a calculé que les valeurs moyennes de Ho et de He chez les chevaux pur-sang étaient respectivement de 0,697 et de 0,684. Lorsque les populations étudiées de chevaux arabes et de chevaux pur-sang sont considérées comme une seule population, les valeurs moyennes de FIT, FST et FIS sont respectivement de 0,063, 0,074 et ­ 0,011. En outre, 4 loci chez les chevaux arabes et 3 loci chez les chevaux pur-sang s'écartent de manière significative du HWE. La valeur PIC moyenne était de 0,63 chez les chevaux arabes et de 0,64 chez les chevaux pur-sang. Par conséquent, les microsatellites comprenant les 15 et 9 loci les plus informatifs avaient une valeur totale > 0,9999 (11 et 7 loci > 0,999) dans chaque population pour l'EP ­ 1 et l'EP ­ 3, respectivement. Il a été conclu que la vérification de la parenté et l'identification génétique peuvent être effectuées avec succès dans les populations de chevaux arabes et de pur-sang en utilisant le panel de marqueurs microsatellites.

Omitting of bougie appears to be safe for the performance of the fundal wrap at laparoscopic Nissen fundoplication.

AIM: Some operative techniques in fundoplication seem to increase the incidence of obstructive symptoms. Some authors believe that using intraesophageal bougie and preparing a short and floppy valve in laparoscopic Nissen fundoplication will help to decrease any possible tight crus repair and wrap and so it is effective to decrease the prevalence of postoperative dysphagia. The aim of this study is to show that there is no absolute benefit of routine insertion of a bougie during laparoscopic Nissen fundoplication in relation to post-operative dysphagia. METHODS: All patients who underwent laparoscopic Nissen fundoplication by a single surgeon between January 2001 and August 2011 were reviewed retrospectively. Esophageal bougie intubation was performed in none of the 154 patients. The operation technique, the duration of the operation, hospital stay and the improvement of the symptoms were assessed. The patients who had esophagitis with Barrett's esophagus and who had hiatal hernia that could not get benefit from medical therapy, were selected for the surgery. Laparoscopic Nissen fundoplication with cruroraphy were done in all patients. RESULTS: Ninety-six of the patients were female and 58 were male. The mean symptom duration was 3.6±0.6 years. The only complication was dysphagia. In eighth week, dysphagia resolved in all patients. CONCLUSION: Laparoscopic Nissen fundoplication can be safely performed without the routine use of an esophageal bougie and it does not increase the postoperative dysphagia rate.

Plasma ghrelin, leptin, and orexin-A levels and insulin resistance after laparoscopic gastric band applications in morbidly obese patients.

AIM: The main cause of obesity is a change in the energy balance in favor of intake. Communication between the hypothalamus and other organs occurs through special peptides, such as ghrelin, leptin, and orexin-A, to provide energy balance. The purpose of this study was to investigate the effects of a laparoscopic gastric band application on insulin resistance and the peptides involved in appetite in morbidly obese patients. METHODS: The study group consisted of 20 patients who were operated on for morbid obesity (body mass index [BMI], 48.3±6.7 kg/m2) and the control group contained 20 healthy, normal-weight subjects (BMI, 22.6±2 kg/m2). We obtained blood samples from the study subjects before surgery and one month after surgery, and once from the control group. We measured plasma levels of ghrelin, leptin, orexin-A, and plasma glucose. RESULTS: Significant weight loss was achieved after surgery (P<0.05). Plasma ghrelin levels were lower in morbidly obese patients (P=0.033), but increased postoperatively (P=0.014), compared with those in the control subjects. Leptin levels were higher in the morbidly obese group (P=0.000), but decreased after the operation (P=0.01). Orexin-A levels were higher in the morbidly obese group (P=0.000), but decreased after the operation (P=0.000). Insulin resistance values also decreased in a manner similar to leptin and orexin-A levels (P=0.000 and P=0.008, respectively). CONCLUSION: Laparoscopic gastric band application results in significant weight loss in morbidly obesity patients, even after one month. We found a decrease in patient BMI, increased ghrelin levels, and decreased leptin and orexin-A levels and insulin resistance.

Serum levels of fetuin A and 8-hydroxydeoxyguanosine in morbidly obese subjects.

Insulin resistance is one of the feature of obesity. Fetuin A is inhibitor of insulin receptor which belongs the family of receptor tyrosine kinase. It has been observed that fetuin-null mice are resistant to diet-induced obesity and they exhibit increased insulin sensitivity. Increased production of reactive oxygen species is suggested to be associated with insulin resistance. Attacks of reactive oxygen species to DNA results in base oxidation. Among the oxidized bases, 8-hydroxydeoxyguanosine is predominant lesion with pro-mutagenic potential. In the present study; measurement of serum levels of fetuin A and 8-hydroxydeoxyguanosine in obese subjects (n=46) and healthy controls (n=22), and examination of the relations between these parameters and insulin resistance have been purposed. Blood samples were taken form morbidly obese subjects after a 12 h fasting. Serum levels of fetuin A and 8-hydroxydeoxyguanosine were measured by ELISA. Statistical analysis was performed by Mann Whitney U test and correlations were examined by Spearman correlation coefficient. Serum levels of total cholesterol, HDL, LDL, VLDL, triglycerides, free T3, free T4, fasting glucose, c-peptide and %HbA1c in the obese group were found to be different from those in the control group. Serum level of fetuin A was found to be higher, 8-hydroxydeoxyguanosine level was found to be lower in the morbid obese group than those in the control group. Fetuin A was found to be positively correlated with HOMA-IR (r:0,40, P<0.05) and negatively correlated with 8-hydroxydeoxyguanosine (r:-0,52, P<0.01). No significant association was determined between body mass index and measured parameters. In conclusion, serum level of fetuin A is high in morbidly obese subjects and is negatively associated with 8-hydroxydeoxyguanosine level in peripheral circulation. Fetuin A may be a promising link between insulin resistance and obesity as well its comorbidities.

Pelvic and retroperitoneal hydatid cysts superinfected with Brucella sp. and review of infected hydatid cysts.

Hydatid disease is a zoonotic infection resulting from the tissue infestation of the larval stage of the parasite Echinococcus granulosus. Hydatid cysts superinfected with pyogenic organisms have been reported previously. Brucellosis is more prevalent in people with close contact to animals and those consuming fresh milk or fresh milk products. Although these two disorders have some similar epidemiological features, we did not encounter any hydatid cyst cases superinfected with Brucella species (sp.) in a search of medical literature (Pubmed). Here, we present a case of hydatid cyst disease superinfected with Brucella and review the literature on other hydatid cyst cases superinfected with pyogenic organisms. We conclude that in regions where brucellosis and hydatid cysts are endemic, cysts may be infected with Brucella sp.

Cervical vestibular evoked myogenic potentials to air-conducted sound in early amyotrophic lateral sclerosis.

OBJECTIVES: Cervical vestibular evoked myogenic potentials (cVEMPs) provide assessment of lower-brainstem lesions affecting their neuronal pathways. We aimed to determine whether cVEMPs to air-conducted sound (ACS) are also abnormal in patients with early stages of amyotrophic lateral sclerosis (ALS), with or without bulbar involvement. METHODS: cVEMPs were recorded in 22 ALS patients and 23 age- and sex-matched healthy volunteers. Their latencies and amplitudes were compared between the ALS patients and the control group. RESULTS: cVEMPs were obtained in all ALS patients and controls. P(13) and N(23) latencies and P(13)-N(23) amplitudes did not significantly differ between controls and ALS patients, either with or without bulbar involvement. CONCLUSIONS: We postulate that the ACS-cVEMP neural pathway is not affected in patients with early stages of ALS, even with clinical findings of bulbar involvement. Therefore, ACS-cVEMP is not a sensitive diagnostic tool for early detection of brainstem involvement in patients with ALS.

A new technique: prolene mesh sphincteroplasty for the treatment of fecal incontinence.

Although successful short-term results have been achieved with the use of overlapping sphincteroplasty and primary end-to- end repairs to treat fecal incontinence due to sphincteric injury, long-term failure rates may reach as high as 50%. This disadvantage associated with tension repairs may be overcome by utilizing a tension-free technique. Here the authors describe a new tension-free technique involving the use of prolene mesh.

Is laparotomy necessary in the diagnosis of fever of unknown origin?

Fever of unknown origin (FUO) is a diagnostic challenge for the practising physician. Detailed medical history, physical examination, non-invasive laboratory tests, and radiologic examinations compose the first level in the diagnostic approach to the FUO. When a diagnosis cannot be established with these procedures, some invasive diagnostic techniques and finally exploratory laparotomy are performed. Although advanced diagnostic measures and imaging-guided less invasive procedures have decreased the need, laparotomy remains as a final diagnostic method for FUO cases. In this study we evaluate the role and importance of laparotomy in the diagnosis of our FUO cases. In 17 out of 126 patients (8 male, 9 female, the median age 35.8 years) hospitalized in our clinic between 1982 and 2002 with the diagnosis of FUO, the diagnosis was established by laparotomy. The diagnosis was made directly in 13 patients, and indirectly (by excluding other diseases) in 2 patients. In several FUO series, the contribution of laparotomy to the diagnosis of FUO was reported as 27-100%. This rate was found to be 88% in the present study. During laparotomy on 17 cases, tissue samples were taken from spleen, liver, intra-abdominal and mesenteric lymph nodes. Pathologic examination of these tissue samples revealed miliary tuberculosis in 4; non-Hodgkin's lymphoma in 3; Hodgkin's lymphoma in 3; liver tumour in 1; hairy cell leukemia in 1; peritonitis carcinomatosis in 1. In the patients with miliary tuberculosis, the liver (3) and/or spleen (2), and/or lymph node (3) revealed caseating granulomas. Laparotomy diagnosed 3 of 5 cases whose abdominal ultrasonography and computerized tomography were normal. In conclusion, although advanced diagnostic methods decreased the need for laparotomy in FUO, if non-invasive and invasive diagnostic measures fail, laparotomy may contribute to the diagnosis. The selection of the patient and the timing are important for laparotomy.

Laparoscopic repair of congenital diaphragmatic hernias.

Bochdalek and Morgagni hernias are the least common congenital diaphragmatic hernias, with the prevalence of Bochdalek hernia being 1/2200 births and the prevalence of Morgagni hernia being 1/1 million births. Although they are usually asymptomatic, congenital diaphragmatic hernias, especially Bochdalek and Morgagni hernias, are diagnosed in early childhood. In adulthood, they are diagnosed incidentally or when they become symptomatic. The repair of congenital diaphragmatic hernia is indicated in all children and symptomatic adults. We present three cases of congenital diaphragmatic hernia, two Morgagni and one Bochdalek hernias, repaired laparoscopically. We describe the operational methods. The results of the operations were satisfactory, with cure defined with radiological images after 1 month. We propose the use of laparoscopy in the repair procedure because it is a safe and effective method. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization stay.

Total intravenous anesthesia versus single breath technique and anesthesia maintenance with sevoflurane for bariatric operations.

BACKGROUND: The choice of anesthetic technique for general anesthesia in morbidly obese patients remains controversial. We aimed to compare blood gases, recovery and hemodynamic parameters using TIVA and sevoflurane anesthesia in bariatric surgery. METHODS: The study was performed with permission of the ethics committee. We studied 40 morbidly obese patients allocated to 2 groups. The total i.v. anesthesia (TIVA) group was named Group T, and the sevoflurane group was named Group S. In Group T, anesthesia induction was achieved with propofol. In Group S, anesthesia induction was achieved by sevoflurane with single breath technique, with maintenance provided with 1-2% volume sevoflurane. Student t, Chi square and ANOVA tests were used for data analysis; p-value < 0.05 was considered statistically significant. RESULTS: There was no significant difference between the 2 groups in demographic data, blood gas values and recovery characteristic. Hemodynamic values were significantly lower in Group T than Group S, during and after the operative period. CONCLUSION: While sevoflurane induction and maintenance is a suitable anesthetic modality for obese patients, TIVA can be applied easily in those patients possessing no extra risk factors other than morbid obesity.

Intraluminal duodenal obstruction by a gastric band following erosion.

BACKGROUND: Duodenal obstruction occurred 4 years following gastric banding for morbid obesity, which had had a good result. METHOD: A 56-year-old female with a history of gastric banding presented with duodenal obstruction. RESULT: Physical and radiological examination was able to give the diagnosis. At surgery, the gastric band in the distal duodenum was removed. She was discharged on postoperative day 4, with no complication. At 6 months following discharge, her nausea and vomiting have not recurred. CONCLUSION: Following gastric banding, band erosion through the gastric wall and internalization into the lumen can cause small bowel obstruction.

Conversion of failed vertical banded gastroplasty to open adjustable gastric banding.

BACKGROUND: Occasionally, patients with failed vertical banded gastroplasty (VBG) present for secondary treatment. We performed the reoperations using adjustable gastric banding (AGB) technique. METHODS: From 1991 to 1997, 80 morbidly obese patients underwent VBG. In 7 (8.7%), staple-line disruption and weight regain were detected within 2 years of follow-up. Conversion to AGB was performed between 1994 and 1998. Meanwhile, another 80 morbidly obese patients underwent primary open AGB. RESULTS: In the 7 patients, staple-line disruption was seen on radiography as a leak of contrast material across the gastric partition. After conversion of "failed" VBGs to AGB, postoperative results have been very satisfactory and similar to those of the primary open AGB group. CONCLUSIONS: VBG is a safe technique, although conversion rates were significant. Staple-line disruption constituted the chief cause of insufficient weight loss and frequently indicated the need for further surgery. Our results of the revisional surgery confirm that the reoperations for failed VBG can be performed using AGB technique.

Laparoscopy in Turkish bariatric surgery: initial experience.

BACKGROUND: The recent application of the laparoscopic method combines minimal invasiveness with reversibility, adjustability and shorter hospital stay. The first laparoscopic bariatric operation in Turkey was performed by us in 1998. METHODS: We report the results in 50 consecutive patients who underwent the laparoscopic application of SAGB between April 1998 and April 1999. The operation setting was the same as for the laparoscopic antireflux procedure. After a closed CO2 pneumoperitoneum (16-18 mmHg), in the first 20 cases five and in the remaining 30 cases four trocars were inserted. A 30 degrees laparoscope was placed on the line between the umbilicus and the xiphoid through a 10 mm trocar. We followed and respected the main steps of the operation as well. Pre and postoperative body weight (BW), body mass index (BMI) and percent excess weight (%EW) values were calculated and compared. RESULTS: Our early results were quite satisfactory and promising. After an average follow-up period of 1 year (range 6-18 months), the 50 patients of our laparoscopic series showed a BW of 74 kg (range 56-112), a BMI of 29 (range 21-40), and an EW of 62% (range 22-86). CONCLUSION: With its lower morbidity rate, shorter hospital stay and better cosmetic results, the laparoscopic approach may be considered the first choice in bariatric surgery.

Value of diagnostic laparoscopy in tuberculous peritonitis.

OBJECTIVE: To assess the safety and efficacy of diagnostic laparoscopy in patients with tuberculous peritonitis. DESIGN: Retrospective clinical study. SETTING: University hospital, Turkey. SUBJECTS: 8 patients (2 women, 6 men; mean age 26 years) who presented with tuberculous peritonitis between January 1994 and January 1996. INTERVENTION: Laparoscopy under local anaesthesia with sedation (the 4 who presented with ascites) and laparotomy (the 4 who presented with an acute abdomen). MAIN OUTCOME MEASURES: Clinical and laboratory findings, biochemical and microbiological analysis of ascites, histopathological examination of specimens, morbidity, and mortality. RESULTS: 4 patients presented with ascites, and 4 with adhesions. Ascites; adhesions between liver and diaphragm, liver and intestines, and intestines and the abdominal wall; miliary nodes on the peritoneal surface; and inflamed haemorrhagic areas on the peritoneum could all be seen at laparoscopy. One of the 8 patients who underwent laparotomy developed a spontaneous enterocutaneous fistula during the early postoperative period. Two of eight patients died, one of an early enterocutaneous fistula and the other of cor pulmonale 3 1/2 months later. The remaining 6 patients survived without complications after antituberculous medical treatment. CONCLUSIONS: Laparoscopy is a safe and accurate method of diagnosis of tuberculous peritonitis.

Stoma adjustable silicone gastric banding versus vertical banded gastroplasty for the treatment of morbid obesity.

BACKGROUND: Among gastric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the results of two different gastric restrictive procedures: vertical banded gastroplasty (VBG) and stoma adjustable silicone gastric banding (ASGB). METHODS: Between 1991 and 1996, 51 patients were treated surgically for morbid obesity: 27 underwent VBG and 24 underwent ASGB. Preoperative body weight (BW), body mass index (BMI) and percentage of ideal body weight (% IBW) were (mean+/-SD): 145.7+/-45.3 kg; 53.9+/-15.9 kg/m2; 249.1+/-73.5% respectively in the VBG group. Corresponding figures for the ASBG group were 132.5+/-22.7 kg; 46.9 7.8 kg/m2 and 207.2+/-35.0%. RESULTS: In the VBG group, the median follow-up period was 26 months (range: 7-47). Eighteen months after the operation BW, BMI, % IBW and percentage of excess weight loss (% EWL) were 85.5+/-26.8 kg, 31.9+/-9.8 kg/m2, 145.4+/-43.9% and 74+/-1% respectively. Complications included incisional hernia (n=1), and bowel obstruction (n=1). One patient died of acute myocardial infarction on the third postoperative day. In the ASGB group, median follow-up time was 19.7 months (range: 18-26). At 18 months postoperation BW, BMI, % IBW and % EWL values were 86.6+/-20.6 kg 30.6+/-6.6 kg/m2 140.6+/-29.3% and 64+/-1% respectively. Gastric wall erosion occurred in two patients and the bands had to be removed. These patients underwent VBG 6 months later. Complications encountered in this group were incisional hernia (n=1), outlet stenosis and reflux esophagitis (n=1), reservoir leakage (n=1) and gastrointestinal bleeding (n=1). Two patients died of pulmonary embolism and acute gastrointestinal bleeding. CONCLUSIONS: Weight reduction was not statistically significant between the two groups. ASGB was easier to perform and less invasive than VBG.