What is the ideal preconditioning time to reduce laparoscopic-induced oxidative stress?

Introduction: Ischaemic preconditioning is the most effective method for the prevention of ischaemic-reperfusion injury; however, no study has examined the question of the ideal time for ischaemic preconditioning. Patients and Methods: The patients were divided into five groups, each group including of 20 patients. The precondition was applied as 1, 5, 10 and 15 min in Groups I, II, III and IV and Group V was the control group. Repeated blood samples were taken to measure the total antioxidant status (TAS), total oxidant status and oxidative stress index (OSI) values, just before insufflation, at the end of the operation and at 6 and 24 h of the post-operative period. Results: A significant difference was observed between the TAS values at the end of the operation and at the sixth post-operative time of the four groups (P = 0.001, 0.000, 0.001, 0.019 and 0.033, respectively). Furthermore, a significant difference was observed between TAS values at the post-operative 24th h of Group III and Group V, and also a significant difference was observed between the OSI values at the post-operative 6th h of Groups III and V. Conclusion: The low OSI and TAS values may interpret as a low degree of oxidative damage. The OSI values at the post-operative 6 h of Groups I and II were lower than those of other groups. We accept this result as low oxidative damage.

Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids.

OBJECTIVE: The aim of this study was to compare the clinical results of LigaSure-assisted hemorrhoidectomy and Milligan-Morgan hemorrhoidectomy as a conventional method in our clinic. MATERIALS AND METHODS: Patients who underwent LigaSure-assisted hemorrhoidectomy or conventional hemorrhoidectomy for grade 3 and 4 hemorrhoids in our clinic between 2009 and 2014 were included in this study. The patient data were reviewed by screening records. Gender, age, preoperative hemoglobin and hematocrit levels, operation time, presence of thrombosis, number of packages, hospitalization time, early and late postoperative complications, prolonged pain presence, and follow-up period were recorded. RESULTS: In this period, surgical interventions were performed on 365 patients diagnosed with hemorrhoids. Among these, 159 underwent LigaSure-assisted operations, while 206 were operated on by conventional methods. One hundred forty-four (39.5%) cases were female, while 221 (60.5%) cases were male. The median age of the patients was 40 (19-82) years in the LigaSure group and 41 (16-78) years in the conventional method group. The operation time was 15 (4-60) min in the LigaSure group and 20 (6-40) min in the conventional method group. Postoperative analgesics were given to the 182 (88.3%) cases in the conventional group and 107 (67.3%) cases in the LigaSure group. The time required for returning to normal daily activity was 6 (1-15) days in the LigaSure group and 7 (1-30) days in the conventional method group. CONCLUSION: In this study, LigaSure was determined to be superior to a conventional method in terms of operation time, hospitalization period, postoperative analgesic requirements, time required for returning to normal daily activity, and postoperative bleeding.

Factors affecting mortality among victims of electrical burns.

BACKGROUND: The aim of this study was to determine the factors affecting mortality rate among patients with an electrical burn. METHODS: A total of 115 patients admitted to the emergency department and hospitalized in the Burn Treatment Center or Intensive Care Unit (ICU) due to the electrical burn, were included in the study. RESULTS: A total of 115 patients (4 female and 111 male) with a mean age of 32.88±12.87 years were included in the study. The mean hospitalization period was 25.03±20.50 days, and the mean total body surface area burned (% TBSA) was 22.83±15.54%. Among those patients, 9 (8.5%) expired, and the remaining 106 were discharged after treatment. In a logistic regression analysis, TBSA >20% (p=0.02, OR: 11.7, CI: 1.38-99.16); ICU requirement (p=0.005, OR: 1.28, CI: 1.08-1.58); erythrocyte transfusion requirement (p=0.02, OR: 12.48, CI: 1.44-107.83); fresh frozen plasma (FFP) requirement (p=0.03, OR: 10.23, CI: 1.18-88.17); albumin requirement (p=0.02, OR: 12.60, CI: 1.44-109.85); admission serum albumin level <3.5 mg/dl (p=0.04, OR: 7.25, CI: 0.82-63.64); and admission hemoglobin level <12 mg/dl (p=0.01, OR: 8.29, CI: 1.57-43.61) were determined as risk factors for mortality in patients with electrical burns. CONCLUSION: In clinical practice, defining a mortality risk analyzer using these factors may be helpful in the management of patients with electrical burns. Additional, more comprehensive studies are required to define the risk factors for mortality and long-term morbidities in patients with electrical burns.

General characteristics of paint thinner burns: Single center experience.

BACKGROUND: The aim of the present study was to present characteristic features and risk factors of paint thinner burns in order to raise awareness and help prevent these injuries. METHODS: Records of patients admitted to the burn unit due to paint thinner burns were retrospectively reviewed, and patients with comprehensive data available were included in the study. Total of 48 patients (3 female and 45 male) with mean age of 27.79±11.49 years (range: 4-58 years) were included in the study. RESULTS: Mean total hospitalization period was 30.25±27.11 days (range: 3-110 days), and mean total burn surface area was 32.53±24.06% (range: 3.0-90.0%). In 31 cases (64.6%), intensive care unit admission was required. Among all 48 patients, 9 (18.8%) died in hospital and remaining 38 were discharged after treatment. Primary cause of death was septicemia (n=7) or respiratory failure (n=6). Inhalation injury was present in 12 of the patients, 6 of whom died (50%). Statistically significant differences were found between expired and discharged patients when compared for presence of inhalation injury (p=0.01) and septicemia (p=0.031). CONCLUSION: Ignition of paint thinner is an important cause of burn injuries that may result in very severe clinical picture. Patients require prompt and careful treatment. Clinicians should be aware that inhalation injury and sepsis are the 2 main factors affecting mortality rate in this group of patients. With increased awareness, preventive measures may be defined. Further studies are warranted to decrease mortality rate in this subgroup of burn patients.

The effect of enteral immunonutrition in upper gastrointestinalsurgery for cancer: a prospective study.

BACKGROUND/AIM: Enteral feeding and immunonutrition (ImN) have been shown to be associated with a number of favorable effects in patients undergoing cancer surgery. In this prospective study, we aimed to assess the perioperative use of enteral immunonutrition in patients undergoing radical gastrointestinal surgery for malignancy. MATERIALS AND METHODS: Forty-one patients with malignancy were included in this study and were randomized into one of the two following nutritional strategies: enteral only (EN) or enteral with enteral immunonutrition (ENIN). These regimens were followed for 7 days perioperatively by all patients. Nutritional parameters and postoperative morbidity, mortality, and length of hospital stay (LHS) were assessed. RESULTS: Serum prealbumin levels increased significantly in the ENIN group (P = 0.033). Moreover, patients in the ENIN group showed a more marked decrease in the rate of postoperative infections (P = 0.021) and anastomotic leakage (P = 0.018) than patients fed with EN. In the EN group, LHS was significantly longer than that in the ENIN group (18 vs. 12 days) (P = 0.032). Rates of overall morbidity and mortality were similar in the two groups (P > 0.05). CONCLUSION: ENIN was found to have a favorable effect on the outcome of radical gastrointestinal surgery for malignancy. Meticulous preoperative assessment of malnutrition and at least a 7-day perioperative enteral use can increase the effectiveness of immunonutrition.

Successful treatment of a hepatic abscess formed secondary to fish bone penetration by laparoscopic removal of the foreign body: report of a case.

Although foreign body ingestion is a common problem in children, it is also seen among adults. Perforation of the gut by a foreign body, followed by migration of the foreign body to the liver is quite rare. Most fish bone ingestions have uneventful outcome. However, occasionally, it can cause serious complications if the gastrointestinal tract is perforated. Herein, a case of liver abscess caused by a fish bone is reported. To the best of our knowledge, it is the first case in our country.