Meibography and tear function alterations in premature ovarian failure.

PURPOSE: Premature ovarian failure (POF) is the deterioration of normal ovarian function before the age of 40. In the presence of chemotherapy, radiation, genetic factors, autoimmune conditions, hypoandrogenemia, hypoestrogenemia and increased gonadotropin hormones, dry eye with early menopause findings may be encountered. The goal of our study is to compare the tear film alterations and meibomian gland status of patients diagnosed with POF at the time of diagnosis with healthy volunteers. METHODS: In our study, 90 patients with POF and 60 control patients were evaluated. Complete ophthalmologic examinations of the patients, ocular surface disease index (OSDI) score, Oxford score for corneal and conjunctival involvement, Schirmer 1 and 2 tests, noninvasive tear break-up time (BUT), lower lid meibomian drop out grades with noncontact meibography, and meibomian gland distortion and shortening scores were compared between the two groups. RESULTS: The mean age was 29.49±2.92 years in the patient group and 29.37±2.85 years in the control group (P=0.830). OSDI scores were statistically significant higher in the patient group (32.11±18.88) compared to the control group (12.93±14.92) (P<0.001). On Oxford scoring, there was a significant increase in the patient group (P<0.001). There was no significant difference between the groups in terms of Schirmer 1 and 2 tests (P=0.195, P=0.117). NIBUT was significantly lower in the patient group (11.93±4.59) compared to the control group (18.72±5.38) (P<0.001). While there was no difference between the groups in terms of lower lid meiboscores or meibomian gland length (P>0.005), there was a significant deterioration in the patient group in the distortion grading showing the morphological evaluation of the meibomian glands (p=0.037). In the ROC analysis, OSDI score (AUC=0.816, P<0.0001) and NIBUT (AUC=0.820, P<0.0001) parameters showed high specifity and sensitivity for the disease. DISCUSSION: Ocular surface damage and dry eye symptoms are observed more frequently in patients with POF. We believe that hormonal insufficiency may cause deterioration in tear film composition, ocular surface damage with changes in tear homeostasis, and a change in the structure of the meibomian glands, starting with distortion at an early age.

Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy?

OBJECTIVE: Postoperative pain management is thought to have an effect on patient comfort, morbidity, and mortality after bariatric surgery. Local anesthetic agents are frequently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method. PATIENTS AND METHODS: A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupivacaine, no action was taken for the other group. Postoperative analgesia was given to both patient groups with the "patient-controlled analgesia (PCA)" device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. RESULTS: TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non-TAP group (p=0.015, 0.018, 0.04, respectively). According to the PCA device data, the analgesic requirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was required more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar. CONCLUSIONS: Laparoscopic TAP block using bupivacaine can be safely administered in morbidly obese patients and reduces postoperative analgesic requirements. Thus, side effects that may develop secondary to the use of analgesics are avoided.

Totally laparoscopic resection and extraction of specimens via transanal route in synchronous colon and gastric cancer.

INTRODUCTION: Synchronous colon and gastric cancer is a rare clinical entity. In the present case, it is aimed to show that in a patient with synchronous colon and gastric cancer, laparoscopic resection can be safely performed and both specimens can be delivered through a natural orifice. In our knowledge, this is the first example showing the delivery of the gastric resection specimen through the anus in a human being. CASE REPORT: Sixty-six years old male patient with an upper gastrointestinal bleeding and obstruction symptoms was admitted to our department and the evaluation revealed an advanced stage gastric and a synchronous colon cancer. A laparoscopic palliative subtotal gastrectomy with a subtotal colectomy was performed. All anastomoses were performed intracorporeally and colectomy and subtotal gastrectomy specimens were successfully delivered via trans-anal route without any difficulty. Despite major abdominal organ resections, the patients required quite less analgesics in the postoperative period. DISCUSSION: Specimen extraction through the natural orifices eliminates the need and problems of performing additional abdominal incisions to the patients which also leads to reduced postoperative pain. Synchronous surgical procedures do not prevent the natural orifice surgery.

Success rate of natural orifice specimen extraction after laparoscopic colorectal resections.

PURPOSE: To date, no data have been available to inform which cases are appropriate for natural orifice specimen extraction (NOSE) after laparoscopic colorectal resections (LCRRs). Our aim was to evaluate the success rate and the factors affecting the failure in patients who were scheduled for NOSE after LCRRs. METHODS: Seventy-two consecutive cases that were intended for NOSE after LCRR were enrolled. The transanal route was always chosen as the first option, and when it failed, the transvaginal route was tried in female patients. If both failed, the specimen was judged as unsuitable for NOSE and removed through an abdominal wall incision. Demographic data, surgical indications, resection localization, implemented procedures, incision sites, specimen extraction methods, specimen sizes, and failures of NOSE were recorded. RESULTS: A total of 349 colorectal resections (240 open and 109 laparoscopic) in a 3-year period were examined. The subset of 72 consecutive patients who met the criteria were analyzed. Five cases required a conversion to open surgery during resections. In the remaining 67 patients, NOSE after LCRR was successful in 49 cases (73.1%) but failed in 18 (26.9%). Specimens were extracted from transanal and transvaginal routes in 37 (75.5%) and 12 (24.5%) patients, respectively. The failure rate of NOSE after LCRR was higher in males, in colonic lesions, and in large-sized tumors. The mean sizes of transanal and transvaginal extracted specimens were 3.5 ± 3.1 and 5.4 ± 1.4 cm, respectively (p < 0.05). The mean size of the tumors in the failed cases was 6.5 ± 4.2 cm (p < 0.05). CONCLUSIONS: Approximately 2/3 of the unselected LCRRs were suitable for NOSE. The success rate increased with female gender, small-sized tumors, and rectal resections.

Histopathological Examination of Explanted Liver After Transplantation in Patients With Cryptogenic Cirrhosis.

OBJECTIVES: Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. MATERIALS AND METHODS: A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. RESULTS: During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-to-male ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. CONCLUSIONS: Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.

Perforated hepatic hydatid cyst into the peritoneum with mild symptoms.

Rupture into the abdominal cavity is a rare but serious complication of hydatid disease that necessitates emergency surgical intervention. We present herein a case with mild abdominal symptoms due to hydatid cyst rupture into the peritoneum after trauma. A 24-year-old man was admitted to the emergency room with mild abdominal pain. His symptoms had started after a fall four days earlier. Ultrasonography and computed tomography showed cystic lesions in the liver and peritoneum with intraabdominal free fluid. He was treated surgically with partial cystectomy and falciformoplasty. Postoperative albendazole therapy was given for two months. There was not recurrence four months postoperatively at control computed tomography.

Effects of deferoxamine on tissue superoxide dismutase and glutathione peroxidase levels in experimental head trauma.

BACKGROUND: This study aims to evaluate the effects of deferoxamine on tissue superoxide dismutase (SOD) and glutathione peroxidase (GPx) brain levels after head trauma. METHODS: Thirty rabbits were divided equally into three groups: group 1 was the sham-operated group, group 2 suffered head trauma (no treatment was given), and group 3 received deferoxamine 50 mg/kg after the trauma. Head trauma was applied unilaterally. One hour after trauma, brain cortices were resected and SOD and GPx levels were determined. One-way analysis of variance and Tukey-HSD tests were used for analysis. Significance was defined as p < 0.05. RESULTS: Baseline SOD levels are preserved in the traumatized side of the deferoxamine-treated group. Although GPx level of the traumatized side of the deferoxamine-treated group decreased significantly, the decrease was significantly less than the nontreated group. CONCLUSION: Trauma leads to a decrease in brain tissue SOD and GPx levels. Deferoxamine suppresses this decrease completely in SOD level and partially in GPx level when given after trauma.