Laparoscopic spleen-preserving distal pancreatectomy for a primary hydatid cyst mimicking a mucinous cystic neoplasia.

Pancreatic hydatid cysts are fairly rare. The disease can be encountered concurrently with systemic involvement or as an isolated pancreatic involvement. We report the first case of spleen-preserving laparoscopic distal pancreatectomy for a pancreatic hydatid cyst. There was no complication or recurrence. A 55-year-old woman was admitted to our centre with epigastric and back pain. Upper abdominal magnetic resonance imaging revealed a solitary cystic lesion with septations at the pancreatic tail level measuring 24 mm × 18 mm, which was initially thought to be a pancreatic mucinous cystic neoplasia. She underwent laparoscopic spleen-preserving distal pancreatectomy and cholecystectomy. Her post-operative course was uneventful and histopathological examination revealed a hydatid cyst in the pancreatic tail.

Effect of Topical Platelet-Rich Plasma on Burn Healing After Partial-Thickness Burn Injury.

BACKGROUND To investigate the effects of platelet-rich plasma on tissue maturation and burn healing in an experimental partial-thickness burn injury model. MATERIAL AND METHODS Thirty Wistar albino rats were divided into 3 groups of 10 rats each. Group 1 (platelet-rich plasma group) was exposed to burn injury and topical platelet-rich plasma was applied. Group 2 (control group) was exposed to burn injury only. Group 3 (blood donor group) was used as blood donors for platelet-rich plasma. The rats were killed on the seventh day after burn injury. Tissue hydroxyproline levels were measured and histopathologic changes were examined. RESULTS Hydroxyproline levels were significantly higher in the platelet-rich plasma group than in the control group (P=.03). Histopathologically, there was significantly less inflammatory cell infiltration (P=.005) and there were no statistically significant differences between groups in fibroblast development, collagen production, vessel proliferations, or epithelization. CONCLUSIONS Platelet-rich plasma seems to partially improve burn healing in this experimental burn injury model. As an initial conclusion, it appears that platelet-rich plasma can be used in humans, although further studies should be performed with this type of treatment.

Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis.

BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3+/-3.3 vs 3.0+/-2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003]. CONCLUSION: In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.

The effects of stem cells and platelet-rich fibrin on colonic anastomosis: An experimental study.

AIM - Anastomotic leakage is among the most common complications following gastrointestinal surgery. MATERIAL AND METHODS - This study aimed to determine the effects of stem cells and platelet-rich fibrin (PRF) on anastomotic healing. The study included 60 rats that were randomly divided into 3 groups, each with 2 subgroups. The study included the control group (no treatment post anastomosis), the PRF group (PRF administered following anastomosis), and the PRF + stem cell group (PRF + stem cells administered following anastomosis). Anastomosis was performed at the descending colon in all groups. Anastomosis bursting pressure was determined, and histopathological and angiographic examination were performed on postoperative D 7. RESULTS - Intraabdominal adhesion was significantly more common in the control group. Anastomosis bursting pressure was significantly higher and angiogenesis was significantly more common in the PRF + stem cell group (P < 0.005). Based on histopathologic examination, vascular proliferation and inflammation were significantly more common in the PRF + stem cell group than in the control group (P < 0.005). CONCLUSION : In cases of risky gastrointestinal system anastomosis, PRF + stem cells might reduce the incidence of anastomotic healing. KEY WORDS: Anastomosis, Platelet-rich fibrin, Stem cell, Wound healing.

Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Hemodynamic changes caused by carbon dioxide (CO(2)) insufflation occur frequently in patients who undergo laparoscopic surgery. One indicator of these changes is corrected QT dispersion (QTcd), an index of myocardial function. Prolongation of QTcd has been associated with cardiovascular morbidity and mortality. We compared the effects of high-pressure (15 mmHg) and low-pressure (7 mmHg) CO(2) pneumoperitoneums on the QT interval, the rate-corrected QT interval (QTc), the QT dispersion (QTd), and the corrected QT dispersion (QTcd) during laparoscopic cholecystectomy. METHODS: Twenty consecutive patients were in a low-pressure pneumoperitoneum group and 32 were in a high-pressure pneumoperitoneum group. A 12-lead electrocardiogram was used to monitor cardiac variables. In all patients, serial electrocardiograms were recorded before anesthesia induction (baseline), immediately after the pneumoperitoneum had been created, every 15 minutes during CO(2) insufflation, and 5 minutes after deflation. Two observers measured the QT intervals independently, and the QTcd was calculated using Bazett's formula. RESULTS: The QT interval and the QTc interval did not change significantly during the study in either group. The QTd and QTcd in the high-pressure pneumoperitoneum group increased significantly during CO(2) insufflation and were significantly higher in the high-pressure pneumoperitoneum group compared with the low-pressure pneumoperitoneum group. Changes caused by CO(2) insufflation were reversible. CONCLUSIONS: Statistically significant increases of QTd and QTcd, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO(2) insufflation in both high-pressure and low-pressure pneumoperitoneums. QTd and QTcd were significantly higher in the high-pressure pneumoperitoneum group than they were in the low-pressure pneumoperitoneum group. QT interval changes were not related to anesthetic agents, surgical stress, hypercapnia, or duration of CO(2) insufflation. Increased intra-abdominal pressure may have caused these changes.

Clinical importance of vitamin D receptor gene polymorphism in invasive ductal carcinoma.

In this study, we aimed to investigate the clinical importance of the vitamin D receptor gene polymorphism in invasive ductal breast cancer. All patients included in the study had clinical T1-2, N0-M0 invasive ductal carcinoma. Patients' demographics, axillary metastasis status, metastatic lymph nodi/total dissected lymph nodes from axilla, histopathologic characteristics of tumors, local recurrences, and survival ratio were assessed. Vitamin D receptor B genotype frequencies in the patient group (P > 0.05) were as follows: B/b, 43 (77%); B/B, 13 (23%). In conclusion, the vitamin D receptor gene B allele does not seem to be related to local recurrence and distant metastasis of invasive ductal cancer of the breast.

Treatment approaches for spontaneous retroperitoneal bleeding.

In this study, we investigated critical issues in the diagnosis and treatment of spontaneous retroperitoneal bleeding. The medical records of 16 patients who were admitted to the emergency department and were diagnosed as having spontaneous retroperitoneal bleeding were reviewed retrospectively. Retroperitoneal bleeding was diagnosed by intravenous contrast-enhanced computed tomography in 8 men and 8 women (median age, 70.5 years; mean hemoglobin level, 7.4 +/- 1.3 mg/dl). Thirteen patients (81%) received conservative treatment. Bleeding was controlled by therapeutic angiographic intervention in two patients (12%) and by surgery in one patient (6%). Two patients (12%) died. Clinicians should suspect retroperitoneal bleeding in anemic patients who are admitted to an emergency department. If active bleeding is detected, interventional radiologic methods should be used as the initial treatment, and surgery can be performed if conservative and interventional radiologic methods fail.

Effect of obstruction on morbidity and mortality in patients with right-sided colon carcinoma: a case-matched study.

In this retrospective case-matched study, our aim was to assess the influence of an obstruction on mortality, morbidity, and long-term survival in patients with right-sided colon cancer. Thirty-seven patients who had undergone curative emergency surgery for the treatment of right-sided colon cancer were matched according to age, American Society of Anesthesiology score, and disease stage with 37 control patients who had undergone curative elective surgery, and the outcomes were compared. There was a trend toward a higher rate of recurrence and a lower rate of survival in patients with an obstruction; however, the difference was not statistically significant. The only independent prognostic factor was tumor site, with hepatic flexure tumors having the worst results. Emergency surgery performed to treat an obstruction does not negatively influence early postsurgical morbidity and mortality. Survival of patients with obstructive colorectal cancer is correlated with certain pathological variables and less strongly associated with clinical variables.

Long-term and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer.

OBJECTIVES: The necessity of comparing oncologic results with the use of minimally invasive surgery in rectal cancer has arisen. The aim of the present study was to evaluate the treatment approach in rectal cancer and to compare the outcomes of laparoscopic and open surgery. METHODS: Patients who underwent surgery for rectal carcinoma between January 2006 and January 2016 in our institution were evaluated. The results were compared between the two groups according to open or laparoscopic surgery. Clinical characteristics, preoperative and postoperative results, pathological examination results, and disease-free survival rates were compared after the surgical procedure. RESULTS: A total of 121 patients were included in the study. Of the patients, 50 underwent open, and 71 underwent laparoscopic surgery. The median follow-up times were 56.75 months in the open surgery group and 55.2 months in the laparoscopic surgery group. Pathological examination revealed similar numbers of lymph nodes in both groups (p>0.05). The duration of hospital stay was statistically significantly lower in the open surgery group than in the laparoscopic group (p<0.05). The rates of disease-free survival were 74% in the open surgery group and 82.5% in the laparoscopic group, and no statistically significant difference was found (p>0.05). CONCLUSION: There was no significant difference in complication and recurrence between laparoscopic and open surgery for rectal cancer in our study. The duration of hospital stay of patients was statistically significantly lower in the laparoscopic group than in the open surgery group. Laparoscopic or open surgical options could be preferred according to the clinical suitability of the patient, experience of the surgeon, and resources of the center in rectal cancer treatment.

Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy: a prospective randomized clinical study.

Chronic postherniorrhaphy pain is a significant complication that can ruin a patient's quality of life. Our study aimed to assess the mesh-nerve interactions and the possible effects of this interaction on nerve morphology and function. Ilioinguinal nerve motor transmission studies using electromyelogram (EMG) were performed before the herniorrhaphy procedure, and Lichtenstein (n=50) or Shouldice (n=50) herniorrhaphies were used for repair. At the end of the first year after surgery, we found no significant differences on ilioinguinal nerve motor conduction studies between the mesh and Shouldice groups. We found a significant correlation between EMG results and inguinal pain. Our results indicates that nerve graft contact does not influence nerve motor conduction. The etiology of postherniorrhaphy chronic pain may be caused by nerve injury resulting in dissection or compression of the nerves.

Primary small intestinal non-Hodgkin lymphoma diagnosed after emergency surgery.

BACKGROUND: The aim of this study was to investigate clinical manifestation, diagnosis, treatment, and prognosis of patients with primary gastrointestinal non-Hodgkin lymphoma (PGI NHL), whose initial presentation was bowel obstruction or perforation. METHODS: Data of patients who underwent surgical intervention due to radiological evidence of perforation or intestinal obstruction and were subsequently diagnosed with intestinal lymphoma at Baskent University hospitals between January 2007 and November 2014 were examined retrospectively. Medical records, clinical history, symptoms, pathological reports, and treatment modalities were analyzed. RESULTS: Study population comprised 17 patients (8 male, 9 female) with PGI NHL and mean age of 52±20.2 years. Symptoms reported by the patients were abdominal pain, nausea, vomiting, weight loss, and loss of appetite. All 17 patients underwent surgical treatment; 12 also received postoperative chemotherapy. Most common pathological subtype was diffuse large B-cell lymphoma (70.5%). Mean follow-up time was 26 months (range: 1-69 months) and 5-year survival rate was 64.3%. CONCLUSION: Initial presentation of PGI NHL may be obstruction with or without perforation; clinicians and surgeons should keep this in mind while assessing patient with bowel obstruction, and particularly patient in fifth decade of life.

Arterial complication of irreversible electroporation procedure for locally advanced pancreatic cancer.

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.

The efficacy of 99mTc-HIG for sentinel lymph node mapping in breast cancer patients.

OBJECTIVE: To evaluate the efficacy of Tc-HIG on SLN identification in patients with early-stage breast cancer. MATERIALS AND METHODS: Seventeen women (18 tumours) with early-stage breast cancer were included. On the day of the operation, 111 MBq Tc-HIG was injected around the tumour or biopsy scar in all patients. Subsequently, dynamic lymphoscintigraphic images were taken for 30 min. After this, static images were recorded at 15-20 min intervals until the SLN was visualized. Patients were taken to the operating room 2-4 h after radiopharmaceutical injection. Before the incision, 5 ml of isosulfan blue dye solution was injected peritumourally in all subjects. Aided by blue dye and gamma probe SLN detection was done during the operation. RESULTS: In 17/18 tumours, SLN was detected with Tc-HIG lymphoscintigraphy. The mean visualization time for axillary SLNs was 49.94+/-11.25 min and for internal mammary SLNs was 52.50+/-10.60 min. In 15 of the tumours, only one SLN was detected in the axillary region. However, in two tumours, SLNs were found in both axillary and internal mammary regions. With blue dye mapping, axillary SLNs were found in 17/18 tumours. With the application of intraoperative gamma probe, all axillary and internal mammary SLNs were detected in 18 tumours. CONCLUSION: We conclude that Tc-HIG may be a suitable agent for SLN detection by lymphoscintigraphy and intraoperative gamma probe application in early-stage breast cancer patients.

Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report.

INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disorder of hematopoietic cells. Gastrointestinal complications of PNH are rare and mostly related with intravascular thrombosis or intramural hematoma. PRESENTATION OF CASE: We describe a case of a man with PNH complicated by intramural duodenal hematoma initially treated with supportive care. Three months after his first admission; he was admitted to the emergency department with abdominal pain, nausea and vomiting. He had undergone to surgery because of duodenal obstruction was treated with duodenojejunal by-pass surgery. DISCUSSION: Patients were healed from gastrointestinal complications could suffer from gastrointestinal strictures, which cause wide spread symptoms ranging from chronic abdominal pain and anorexia to intestinal obstruction. CONCLUSION: We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract.

Effect of static magnetic field on experimental dermal wound strength.

CONTEXT: An animal model. AIM: We sought to evaluate the effect of static magnetic fields on cutaneous wound healing. MATERIALS AND METHODS: Male Wistar rats were used. Wounds were created on the backs of all rats. Forty of these animals (M group) had NeFeB magnets placed in contact with the incisions, either parallel (Pa) and perpendicular (Pr) to the incision. The other 40 animals (sham [S] group) had nonmagnetized NeFeB bars placed in the same directions as the implanted animals. Half of the animals in each group were killed and assessed for healing on postoperative day 7 and the other half on postoperative day 14. The following assessments were done: gross healing, mechanical strength, and histopathology. STATISTICAL ANALYSIS USED: Intergroup differences were compared by using the Mann-Whitney U or t test. Values for P less than 0.05 were accepted as significant. RESULTS AND CONCLUSIONS: There were no differences between the magnetic and sham animals with respect to gross healing parameters. The mechanical strength was different between groups. On postoperative day 14, the MPr14 had significantly higher scores than the other groups. When static, high-power, magnetic fields are placed perpendicular to the wound, increased wound healing occurs in the skin of the experimental model.

When is transthoracic approach indicated in retrosternal goiters?

PURPOSE: It is critical to differentiate among pathologies of substernal thyroid gland diseases because surgical approaches (i.e., median sternotomy or thoracotomy) might also include a cervical incision. The aim of this study was to analyze the features of patients with goiter who underwent a thyroidectomy via a cervical incision and a median sternotomy or thoracotomy. METHODS: We reviewed 9 cases of thyroid disease in patients undergoing thoracic incisions with or without a cervical incision for varying indications between March 2003 and Jun 2009 were reviewed. Thyroidal masses were removed via a median sternotomy in six patients and thoracotomy in three patients. Split median sternotomy combining thoracotomy was performed in 1 patient. Cervical incision was added in all patients. RESULTS: Pathologic examination revealed multinodular goiter in 5 patients, thyroid carcinoma in 3, and reidel thyroiditis in 1. All patients were extubated in the early postoperative period. There was no postoperative mortality or morbidity. The mean hospital stay was 8.6 days (range, 4-11 days), and mean follow-up was 24.3 months (range, 4-39 months). CONCLUSIONS: We recommend the use of transthoracic approaches, such as median sternotomy and thoracotomy for retrosternal goiter for surgical exposure, because they provide a wide exposure and facilitate removal of the mass. By using median sternotomy and thoracotomy, we can avoid catastrophic results, such as hemorrhage, as well as completely remove malignancies.

Solitary fibrous tumor of the lesser omentum: report of a rare case.

We herein describe the case of a 51-year-old male who presented with a mass of the epigastric region. Preoperative contrast enhanced abdominal computerized tomography revealed a solid mass between the left liver lobe and stomach. Histopathologic examination diagnosed the mass as a solitary fibrous tumor. Although solitary fibrous tumors are rare, especially in the abdomen of adults, they are generally benign, but malignant cases have also been reported. Long-term follow-up will be necessary to determine whether the surgery has been curative.

Multidetector CT findings of spontaneous rupture of hepatic adenoma in a patient with hepatic adenomatosis.

Hepatic adenomatosis (HA) is characterized by more than 10 adenomas in the liver, frequently scattered within both lobes. The potential for spontaneous bleeding, rupture, and malignant transformation is known. In HA, tumors show hypervascularization on arterial angiography, computed tomography (CT), and magnetic resonance imaging. We report the case of a 32-year-old woman who presented with a large intraparenchymal and subcapsular hematoma in the liver, and an underlying large adenoma with atypical radiologic characteristics detected with multidetector CT imaging. On follow-up CT examination, a large adenoma was clearly visualized at the site of the previous hematoma.

Laparoscopic cholecystectomy in patients undergoing continuous ambulatory peritoneal dialysis: a case-control study.

This case-control study assesses laparoscopic cholecystectomy (LC) in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis. Eleven patients receiving peritoneal dialysis treatment and 33 patients without end-stage renal disease who had undergone an elective LC were compared. Medical records were reviewed, and laboratory values and outcomes and results were analyzed. The peritoneal dialysis group showed a higher frequency of associated disease and previous abdominal surgery; a lower hemoglobin and platelet count; and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. Statistically significant between-group differences were found with regard to postoperative complications and postoperative hospital stay days. One procedure in each group was converted to an open cholecystectomy. No patient in the peritoneal dialysis group who underwent a LC had peritonitis. No other catheter-related complications occurred. LC may be performed with low complication rates in patients undergoing continuous ambulatory peritoneal dialysis with an experienced team.

The value of preoperative vascular imaging in the selection and success of hemodialysis access.

The purpose of this study was to determine the value of preoperative vascular imaging (PVI) in the selection of an arteriovenous fistula (AVF) for hemodialysis with respect to site selection, maturation, patency, and functionality. We retrospectively evaluated 482 AVFs and arteriovenous grafts (AVGs) created in 321 patients who were regularly undergoing hemodialysis at our university's hemodialysis centers. The patients were divided into two groups according to PVI status. The patients in group 1 (n = 260) underwent Doppler ultrasonographic evaluation and venographic studies as well as physical examination before operation. The patients in group 2 (n = 222) underwent only physical examination before operation. Both groups were compared with respect to vascular access type, access maturation rate, and duration of access patency. In group 1, central veins were also evaluated for possible stenosis, and significant asymptomatic stenosis was treated with interventional techniques. The patients in group 1 were significantly older than those in group 2 and had a significantly higher mean number of previous central venous catheterizations and vascular access sites. At the initiation of the study, 234 of the vascular access sites had matured with a success rate of 90% in group 1. In group 2, however, 152 (68.5%) of the vascular access sites had matured. AVGs of the vascular access type were created in 31.5% of patients in group 1 and in 12.6% of patients in group 2. The mean duration of primary patency in group 1 overall (i.e., AVFs and AVGs) was 14.7 +/- 16.8 months, and the 6-month and 12-month patency rates were 72% and 46%, respectively. The mean duration of primary patency in group 2 overall was 11.9 +/- 9.4 months, and the 6-month and 12-month patency rates were 71% and 41%, respectively. Patients in group 1 had a significantly longer mean primary patency time than did those in group 2 (P = 0.024). Sixty-six cases of central vein stenosis were detected during PVI studies and treated interventionally. After those interventions, 38 AVFs and 28 AVGs were created, and all matured sufficiently without exception. As an adjunct to physical examination, PVI evaluations (venography, Doppler ultrasonography) can be used to determine the likelihood of the maturation of vascular access sites and can reveal problems such as central vein stenosis, which can then be treated promptly with percutaneous intervention. In patients with end-stage renal disease, these interventions should lead to a decrease in morbidity and mortality and improved quality of life.