Effect of hyperbaric oxygen in hepatopulmonary syndrome: an innovative experimental study.

OBJECTIVE: This study aimed to analyze the effect of hyperbaric oxygen treatment (HBOT) in hepatopulmonary syndrome (HPS). MATERIALS AND METHODS: Five-month-old female Wistar-Albino rats were randomly divided into three groups: Group I, the control group; Group II, the cirrhosis group; and Group III, the cirrhosis group + HBOT group. Rats were exposed to HBO sessions (2.4 atm./60 min) for 20 days. Animals were sacrificed 24 hours after the last HBO session. Biochemical analysis, oxygenation parameters, NO and NO synthase (NOS) levels, histopathological changes in the liver and lungs, and pulmonary artery diameter were measured. RESULTS: A total of 24 rats (10 rats were included in Group I, six rats in Group II, and eight rats in Group III) weighing 220-250 g were included in the study. Significant differences were observed for NO and NOS (9.10±1.05 to 12.17±1.85 µmol/L, p<0.05 and 0.46±0.31 to 1.17±0.39 U/ml, p<0.05, respectively) at baseline and day 36 only in group II. Inflammatory cell infiltration and bronchial injury were significantly increased in group II compared to group I (p=0.007 and p=0.008, respectively) but not in group III (p=0.266 and p=0.275, respectively). Pulmonary artery diameter was significantly lower in group III compared with group II at all sites in both lungs (p<0.05). CONCLUSIONS: HBOT may be a promising treatment for HPS by reducing NO and NOS activity, perialveolar arteriolar dilation, lung inflammation, and injury and guiding future clinical trials.

Comparison of extraperitoneal and intraperitoneal laparoscopic procedures for intracranial pressure increase: a prospective clinical study.

OBJECTIVE: According to the literature, higher levels of both intracranial pressure (ICP) and intraabdominal pressure (IAP) are related in a way that suggests a causal relationship. An increase in ICP can cause major neurological problems both during and after laparoscopic surgery. In this study, we aimed to examine the increase in ICP between totally extraperitoneal (TEP) inguinal hernia repair and laparoscopic cholecystectomy. PATIENTS AND METHODS: We investigated 52 individuals who underwent laparoscopic surgery for the treatment of inguinal hernia (n = 26) or had a laparoscopic cholecystectomy (n = 26). The optic nerve sheath diameter (ONSD) was assessed before the procedure (T0), 10 minutes after carbon dioxide insufflation (T1), and immediately before extubation (T2). RESULTS: There were significant differences in the ONSD values between the two groups as a function of time (p = 0.001). In terms of ONSD, the laparoscopic cholecystectomy value (LV) group showed a greater shift from T0 to T1 and T2 than the inguinal hernia value (HV) group. At T1, the ONSD values of both groups were considerably higher than those of T0 and T2. The impact of the extraperitoneal and transperitoneal laparoscopic methods on ICP was investigated. The ONSD value reached its maximum at T1 in both groups. At all measurement periods, the ONSD values of the LV group were noticeably higher than those of the HV group. CONCLUSIONS: The diagnostic accuracy of ONSD ultrasonography is an important approach for determining the ICP level. During the decision-making process of TEP inguinal hernia repair, this study can guide medical professionals in the evaluation of elevated ICP.

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study.

PURPOSE: The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia. METHODS: This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations. RESULTS: It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien-Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien-Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02). CONCLUSION: The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

The relationship between self-efficacy of diabetes management and well-being in patients with type 2 diabetes.

BACKGROUND: Self-efficacy is defined as the ability of an individual to perform an action successfully or her/his perception of being able to control events. The self-efficacy perception of diabetes management may affect well-being of the patient. AIMS: This study aimed to examine the relationships between self-efficacy of diabetes management and well-being in patients with type 2 diabetes. SUBJECTS AND METHODS: The study used a descriptive correlational design. Sample of the study included 200 patients with type 2 diabetes. Sociodemographic and disease-related questionnaire form "Self-Efficacy Scale for Diabetes Management" and "Well-Being Questionnaire" have been used as data collection tools. Multiple linear regression analysis was performed to explore the predictors of well-being in patients with type 2 diabetes. RESULTS: Self-efficacy level, age, level of compliance with treatment, and state of doing exercise were found to be statistically significant predictors of well-being in type 2 diabetic patients. Self-efficacy level for diabetes management was found to be the strongest predictor of well-being in patients with type 2 diabetes. CONCLUSION: Self-efficacy level of diabetes management is a factor that affects well-being in type 2 diabetes patients and it should be considered during interventions for improving the well-being of patients.

Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy.

BACKGROUND/OBJECTIVES: Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. DESIGN: Retrospective cohort study. SETTING: University hospital in Turkey. PARTICIPANTS: 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. MEASUREMENTS: "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. RESULTS: The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. CONCLUSIONS: A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.

Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia.

PURPOSE: In our study, we aimed to evaluate neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with Community-acquired pneumonia (CAP). METHODS: This is a retrospective study consisting of 114 patients with CAP and 50 control subjects. Patients with CAP were divided into 2 groups, as inpatient and outpatient. RESULTS: The main findings of our study were that NLR, PLR and CRP levels were significantly higher in CAP than those in the control group. These biomarkers were also higher in inpatient group than outpatient group, but not statistically significant. CONCLUSION: To our knowledge, this is the first study which investigated the role of NLR and PLR as inflammatory biomarkers and the difference in inpatients and outpatients with CAP and their correlation with CRP values in children. However, larger prospective studies are needed to establish their utility as a predictor for the presence of CAP (Tab. 1, Fig. 2, Ref. 9).

The effect of chronic constipation on the development of inguinal herniation.

OBJECTIVE: To investigate the effect of constipation on the development of inguinal herniation and type of herniation using the Constipation severity scale. METHODS: A total of 100 patients who underwent surgical inguinal hernia repair (study group) and 100 healthy volunteers without inguinal herniation (control group) were included in this study. The constipation severity scale was administered to all patients. The type of the herniation was classified using Nyhus scale during surgery and the side of the herniation was recorded on completed questionnaires. The obstructive defecation sub-scale score, colonic inertia sub-scale score, pain sub-scale score, and the total score were recorded for each patient and the association between constipation and the development of inguinal herniation was investigated. RESULTS: The mean age of patients in Group 1 and 2 was 40.92 ± 17.80 and 33.71 ± 9.13, respectively. There was a significant difference between the two groups in terms of obstructive defecation and colonic inertia sub-scale scores (p < 0.01). In addition, except for the pain sub-scale score, there were significant differences between Nyhus hernia types with regard to sub-scale scores of the constipation severity scale in patients in Group 1 (p < 0.01). CONCLUSION: Significantly higher obstructive defecation subscale, colonic inertia subscale, pain subscale, and total scores in the study group as compared to controls shows that constipation may represent an important etiological factor for the development of inguinal herniation.

Impact of allyl disulfide on oxidative damage and liver regeneration in an experimental hepatectomy model.

BACKGROUND: We investigated the effects of allyl disulfide (agarlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model. MATERIALS AND METHODS: In the study, 24 female Wistar albinorats weighing approximately 200-250 g were used. Group 1:The rats in the experimental group all received a 70%hepatectomy and were fed an Allyl disulfide (30 λg kg day,Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CASNumber: 2179-57-9, formula weight: 146.27 g mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. Forbiochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular),fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells,dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinu soidallumen and ki-67 proliferation index at hepatocytes were examined. RESULTS: A significant difference between group 1 and group2 was observed regarding the existence of regeneration,(p:0.06), the occurrence of nuclear pleomorphisms (p:0,001)and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemiastatus in the sinusoid lumens (p:0.013 and p:0.001,respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups(p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively).The average total bilirubin (T. Bili) values were 0,12,0,08 and 0,04 in the allyl disulfide group, control group andSham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively.This variation among the groups is also statistically significant (0.001). CONCLUSION: We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage. ABBREVIATIONS: Postop: post-operative, Preop: pre-operative,SGOT(AST): serum glutamic oxaloacetic transaminase,SGPT(ALT): serum glutamate-pyruvate transaminase, CRP:C- Reactive protein, MDA: Malondialdehyde, DAS: Garlicextract diallyl sulfide, AGE: aged garlic extract.

REVERSIBLE CLINICAL AND MAGNETIC RESONANCE IMAGING FINDINGS IN LATE-ONSET COBALAMIN C DEFECT.

Cobalamin C (Cbl C) disease is an inborn error of intracellular cobalamin metabolism. Two distinct clinical types are defined according to the age of onset. We describe an 8 year old girl with late-onset Cbl C disease presenting with neuropsychiatric symptoms. Mutation analysis revealed homozygous c.394C>T (p.R132X) mutation in the MMACHC gene. Serial magnetic resonance imaging (MRI) before and after the treatment are provided. MRI of the brain before treatment showed bilateral patchy focal hyperintensities in the white matter and cortical atrophy. After treatment with intramuscular hydroxycobalamin, oral folinic acid, oral betaine, normalization of MRI findings can be achieved in addition to clinical improvement. We present this case to draw attention to the reversibility of clinical and MRI findings in the late onset Cbl C disease after treatment.

Endoscopic clipping versus band ligation in the management of bleeding esophageal varices.

BACKGROUND: The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. METHODS: Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. RESULTS: Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). CONCLUSIONS: With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.

Does estrogen cause low conversion rates in laparoscopic cholecystectomies for acute and chronic cholecystitis in women?

Laparoscopic cholecystectomy is the preferred treatment for symptomatic cholelithiasis. Severe local inflammation and scar formation are commonly responsible for conversion to open surgery. Fibrosuppressive effects of estrogen on peritoneal inflammatory conditions could provide low, dense fibrosis or scar formation around the gallbladder and make laparoscopic cholecystectomy easier in women and we believe that male sex is a conversion factor in laparoscopic cholecystectomy.

The management of liver hydatid cysts by percutaneous drainage.

OBJECTIVE: To investigate the effect of percutaneous drainage on liver hydatid cysts. DESIGN: A retrospective case study. SETTING: Department of Surgery, Selçuk University, Konya, Turkey. PATIENTS: Forty-five patients with 83 liver hydatid cysts (types I and II according to the classification of Gharbi and colleagues) followed up for a mean of 30 months (range from 14 to 36 months). INTERVENTION: The cysts were drained percutaneously with ultrasonographic guidance and then irrigated with 0.05% silver nitrate solution through a fine needle. Albendazole was administered 48 hours before percutaneous drainage and for 2 months after the procedure to prevent the implantation of spilled scolices. MAIN OUTCOME MEASURES: Complications of the procedure, decrease in size of the cyst cavity, recurrence and dissemination of the cysts. RESULTS: All the cysts were treated successfully by percutaneous drainage. Anaphylactic shock developed in 1 (2.2 %) patient, and mild allergic reactions were observed in 2 (4.4 %) patients during the interventional procedure. Follow-up ultrasonography and CT demonstrated a statistically significant (p < 0.01) decrease in the mean cyst size. Recurrence and dissemination were not observed during the follow-up period. CONCLUSION: Percutaneous fine-needle aspiration and drainage is effective for managing cystic liver hydatid disease in selected cases.

The effects of splenic artery ligation in an experimental model of secondary hypersplenism.

OBJECTIVE: To induce hypersplenism in rats by splenic vein ligation and to investigate the effects of splenic artery ligation in this model. BACKGROUND: Selective arterial embolisation and splenic artery ligation (SAL) are used in the treatment of secondary hypersplenism in some medical centres but these methods are not common. MATERIALS AND METHODS: Thirty male Saprague-Dawley rats were allocated to three groups (n = 10). The first group underwent laparotomy, the second and third groups underwent laparotomy and splenic vein ligation. At the end of the third week, laparotomy was performed in the first and second groups and splenic artery ligation in the third group. Erythrocyte, leukocyte and platelet counts were performed weekly. At the end of the sixth week, the animals were sacrificed and the spleens were taken for histopathologic examination. RESULTS: In the second and third groups, after splenic vein ligation, the erythrocyte and platelet counts were significantly reduced at the end of the second week (p < 0.01). In the second group, which underwent splenic vein ligation only, the levels remained low throughout the experiment. In the third group, after splenic artery ligation, there were rises in both erythrocyte and platelet counts; the levels were similar to the levels in the control group at three weeks after splenic artery ligation (p > 0.05). No significant changes were observed in the leukocyte counts throughout the experiment (p > 0.05). CONCLUSIONS: Splenic vein ligation successfully induces experimental secondary hypersplenism. This state can be ameliorated by splenic artery ligation.

Effect of laparoscopic cholecystectomy on platelet aggregation.

The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on platelet function. We operated on 40 women with symptomatic gallbladder stone, 20 of whom (study group) underwent laparoscopic cholecystectomy and 20 of whom (control group) open cholecystectomy. Patients with a history of bleeding, abnormal platelet count, or systemic disorders and those who were on salicylates, heparin, or oral anticoagulants were excluded. Blood parameters were checked at the beginning and the end of the operation, including platelet aggregation using adenosine 5'-diphosphate (ADP), collagen, and ristocetin in a whole-blood aggregometer. Platelet aggregation was evaluated by percent aggregation. Platelet aggregation due to collagen and ristocetin increased significantly at the end of the operation in the study group (p < 0.001). Aggregation due to ADP did not differ significantly from the start to the end of the operation. Control group results did not show any differences. Although the clinical findings of aggregated platelet are not frequently observed in practice, we suggest that laparoscopy increases platelet aggregation.

Transanal electrovaporisation of rectal tumours.

OBJECTIVE: To present our early results with endoscopic transanal electrovaporization of rectal tumours. DESIGN: Retrospective study. SETTING: Department of Surgery, Faculty of Medicine, University of Selçuk. SUBJECTS: 10 patients, 4 with malignant and 6 with benign lesions. INTERVENTIONS: Vaporization of the tumour using a new ridged roller electrode, the VaporTrode, and a standard 24F urological resectoscope. MAIN OUTCOME MEASURES: Morbidity and recurrence. RESULTS: There were no complications and all adenomas were vaporized completely. 2 patients with obstruction required a further treatment 3 and 5 months later because of recurrence. Median duration of operation was 22.5 minutes (range 10-38) and median duration of hospital stay was 3 days (range 1-4). CONCLUSION: The VaporTrode is a safe and potentially useful tool for transanal excision of rectal tumours, the long term efficacy of which should be tested in larger series of patients.

Open drainage versus overlapping method in the treatment of hepatic hydatid cyst cavities.

In order to compare the results of open drainage and overlapping methods, 58 consecutive patients with uncomplicated hepatic hydatid disease were investigated between January 1990 and January 1997. The cavities were obliterated by overlapping method in 26 patients and were left open into the peritoneal cavity following partial pericystectomy in 32 patients. Postoperative complications and follow-up results of ultrasonography (US) and computed tomography (CT) were compared between the two groups. In total, there were 56 cysts in the obliterated group and 83 cysts in the open drainage group. There was no significant difference in age, sex, mean diameter of the cysts, US features of the cysts according to the Gharbi classification, and median follow-up. Mean hospital stay was 10 days in the overlapping group and 7.5 days in the open drainage group (P = 0.033). No postoperative complication was observed in the obliterated group and nearly half of the cyst cavities could not be detected in the early postoperative period by US and CT. Pleural effusion (n = 1) and biliary fistula (n = 1) were detected in the open drainage group which disappeared spontaneously. In the open drainage group, US and CT surveillance revealed that the cyst cavities were reduced in size and the echo pattern was changed in the early postoperative period, whereas the appearance changed into pseudotumor view in the late postoperative period. In conclusion, the cyst cavities disappear perfectly in the overlapping group. Treating the cyst cavity by open drainage is an easy, effective and safe technique. Open drainage can be a 'method of choice' for patients with multiple hydatid cysts and for cysts where management is difficult or unamenable to other methods, but the residual cyst cavities may be misinterpreted as a new cyst by an inexperienced radiologist.

Effect of octreotide (Sandostatin 201-995) on bile flow and bile components.

Octreotide (Sandostatin 201-995) has an inhibitory effect on gastric, intestinal, and pancreatic secretions and hepatic and splachnic blood flow. We examined the effects of octreotide on bile flow and bile components in 10 patients with T-tube choledochostomy. A Fogarty balloon catheter was inserted distal to the T-tube of these patients for measurement of bile flow and bile components. Bile samples were obtained to analyze bile acid, phospholipid, lipoprotein, and cholesterol, and bile flow measurements were performed every 15 min for a period of 90 min before study and after normal saline and octreotide administrations. While octreotide had an inhibitory effect on bile flow, the concentrations of bile acid, phospholipid, and lipoprotein in bile were increased with octreotide.

Is urinary bladder pressure a sensitive indicator of intra-abdominal pressure?

BACKGROUND AND STUDY AIMS: The accuracy of transurethral bladder catheter pressure in reflecting intra-abdominal pressure is well defined in experimental studies and case reports but not in controlled clinical trials. PATIENTS AND METHODS: We compared bladder pressure with insufflator pressure during laparoscopic cholecystectomy in 40 patients. Measurements were made at four pressure levels of the insufflator: 0, 5, 10 and 15 mmHg. RESULTS: When the insufflator displayed 0, 5, 10, and 15 mmHg (0, 6.8, 13.6 and 20.4 cmH2O), and the mean bladder pressures measured 2.5 +/- 1.4, 7.3 +/- 1.5, 12.9 +/- 1.6 and 19.7 +/- 1.5 cmH2O, respectively. The two measurements correlated well with each other (r = 0.973, P < 0.0001). CONCLUSION: We concluded that bladder pressure measured by transurethral catheter was equal to insufflator pressure during laparoscopy, and that this was a valid indicator of intra-abdominal pressure.