MATRA-A: A study on massive transfusion.

BACKGROUND: We use massive transfusion in various clinical conditions and it is associated with high mortality. Although some massive transfusion protocols improve patient outcomes, the clinical circumstances requiring it are not well defined. METHODS: MATRA-A is a multicenter retrospective study. Six University and Training Research Hospitals in Ankara participated in the study. We collected clinical data on patients (>18 years) who received massive transfusions (≥10 units/24 h) from 2017 through 2019. RESULTS: Overall, 167 (0·27% of transfused patients) received a massive transfusion of 2586 units of red blood cells (1·5% of total RBCs transfused). The median interquartile range values for RBCs, fresh frozen plasma (FFP) and platelets were 13 (11-176), 16 (9-33) and 4 (0-11), respectively. Surgical patients received 90% of massive transfusions. The most common clinical indications for massive transfusion were cardiovascular diseases (42·6%), trauma (20·3%) and malignancies (11%). FFP: RBC: Platelets ratio was 1·9:1:0·5. The overall and trauma-related mortality rates were 57·4% and 61·8%, respectively. The hospital mortality rates of trauma patients that received high vs. low ratio (FFP: RBCs > 1:1·5 vs. ≤1:1·5) transfusions were 47·6% and 86·6% and the difference was statistically significant (P = 0·03). CONCLUSION: Cardiovascular diseases and trauma occasion are the most common causes of massive transfusion. It is infrequent in clinical settings and is associated with high mortality rates. Additionally, in massively transfused trauma patients, a high FFP:RBCs ratio seems to be associated with increased survival. Focused prospective studies are required to define the areas that need improvement on a national scale.

Surgical management of insulinomas at the Azerbaijan Medical University: a retrospective study of 21 cases over a 10-year period

Background/aim: This study represents the first report that evaluates the experience gathered from diagnosis, surgical treatment and outcome of insulinoma patients from Azerbaijan. Materials and methods: We retrospectively review of insulinoma patients for a 10-year period. Collected data included patient demographics, laboratory and imaging tests, detailed surgical reports, histopathological examination of resected specimens, and clinical follow-up. Results: Twenty-one insulinoma patients were identified. Male patients comprised 52.4%; mean age was 44 years. Mean time to diagnosis was 14 months; 61% patients had ≥3 medical referrals due to hypoglycemia-related symptoms. Diagnosis sensitivity of CT, MRI and US was 85%, 80%, and 55%, respectively. The mean glucose, insulin, C-peptide levels were 35.7 ± 9.5 mg/dL, 33.5 ± 21.9 µU/mL, and 3.74 ± 1.88 ng/mL, respectively. Pancreatic head and tail were the most frequent tumor locations; mean tumor size was 1.5 ± 0.7 cm. No statistical association was found between the tumor size and preoperative glucose, C-peptide and insulin levels. Distal pancreatectomy and enucleation were the most common surgical procedures. Local tumor recurrence rate was 14%. There was no mortality. Conclusions: To prevent delayed diagnoses, physicians should be familiar with the typical symptoms of these rare tumors.

A strategical re-thinking on National Blood Donor Pool: Anti-HBc positivity related re-entry mechanisms.

BACKGROUND AND OBJECTIVES: Screening of blood donations for antibodies against hepatitis B core antigen (anti-HBc) is used to prevent transfusion transmitted hepatitis B virus (HBV) infection. In this study, we studied the magnitude of blood donor gain by using a re-entry mechanism in our Blood Bank of Gulhane Military Academy of Medicine. MATERIALS AND METHODS: Between January and May 2013, 5148 voluntary blood donors were screened by ELISA method for HBsAg, anti-HBc total and other screening markers, prospectively. Samples with repeated reactivity for the presence of anti-HBc were further tested with four supplemental assays. RESULTS: We detected 515 (10%) anti-HBc positive and 4612 (90%) anti-HBc negative cases in 5127 HBsAg negative serum samples. A total of 461 (89.5%) blood units were reactive for at least one additional serologic parameter and 54 were (10.5%) negative. Isolated anti-HBc positivity rate was 1.3% (69/5127). In the isolated anti-HBc positive samples, 54 were also anti-HBe and HBeAg negative. HBV DNA was not detected in any of the samples. CONCLUSION: Applying the EDQM criteria would decrease our blood donor loss from 10% to 5.4%. As alternative re-entry mechanisms have already been presented in the literature, institution of a new policy is needed to enhance the limited blood donor pool in our system.

Is one-size-fits-all strategy adequate for platelet storage?

BACKGROUND: Platelet suspensions (PSs) are stored at room temperature. However, recent reports show that PSs stored at 4 °C possess superior hemostatic properties. We compared the viabilities and thrombin generation capacities of PSs stored either at 4 °C or 22 °C hours. MATERIALS AND METHODS: Twenty units of apheresis derived platelets (ADPs) from 20 male donors and 20 units of random platelet suspensions (RPSs) from another 20 male donors were obtained. Half of the ADPs and half of the RPSs (10 units/per group) were stored at 4 °C, the other halves of ADPs and RPSs (10 units/per group) were stored in agitators at 22 °C for 48 hours. The flow cytometric viability tests and thrombin generation tests of the PSs were assessed. RESULTS: The viabilities of both ADPs and RPSs group platelets, stored either at 4 °C or 22 °C for 48 hours, were not statistically significantly different. The ADPs and RPSs stored at 4 °C generated significantly higher peak thrombin levels than the platelets stored at 22 °C. Moreover, the ADPs group stored at 4 °C showed significantly shorter time to thrombin generation and reach peak levels. CONCLUSION: The PSs stored at 4 °C showed higher and faster thrombin generation capacities than the room temperature PSs. Given the superior hemostatic properties of refrigerated platelets, creating different storage temperature capabilities for specific transfusion purposes may be a prudent approach, especially for improving the outcome of bleeding trauma casualties.

Body mass index and ghrelin levels after laparoscopic Nissen fundoplication.

PURPOSE: The study aims to evaluate the changes between body mass index (BMI) and ghrelin levels after laparoscopic Nissen fundoplication (LNF). METHODS: Twenty-four consecutive patients with gastroesophageal reflux disease who were scheduled for LNF consented to participate in the study. The participants' age, sex, preoperative (phase 0), postoperative 1st week (phase 1) and postoperative 4th week (phase 2) dysphagia scores, plasma ghrelin levels, and BMI were recorded. RESULTS: Compared to the preoperative level (phase 0), ghrelin was decreased in both phase 1 and phase 2. A strong correlation in the changes in the ghrelin values and BMI between phase 0 and phase 2 was detected. There was a strong, statistically significant difference in the changes in the BMI values between phase 1 and phase 2. CONCLUSIONS: Total plication of the fundus impairs its ghrelin-secreting functions for up to 4 weeks and is accompanied by weight loss.

An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases.

INTRODUCTION: Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. METHOD: Participants from a training tank battalion were randomised. Data collected included age, body mass index, mean arterial pressure, hand dominance, femoral artery diameter and skin thickness. The study involved tourniquet application times (AT) and application success rates in basic, after-training and eyes-closed phases. Doppler ultrasound was used to identify the presence or absence of popliteal, radial and ulnar artery pulses. RESULTS: A total of 102 trainees participated. In the after-training phase, the left and right upper extremity ATs were 35 ± 13.1 s, and 34.8 ± 13.5 s and the right and left lower extremity ATs were 20.6 ± 6.0 s and 20.5 ± 5.5 s, respectively. The overall tourniquet success rates in three successive study phases were 69.6%, 82.4% and 91.2%, respectively. A negative significant relationship was found between extremity circumference and tourniquet success. DISCUSSION: The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.

Results of combat medic junctional tourniquet training: a prospective, single-blind, randomized, cross-over study.

BACKGROUND: Bleeding remains the leading cause of potentially preventable deaths both in military and civilian pre-hospital trauma settings. Conventional extremity tourniquets do not control bleeding if an iliac artery or a common femoral artery is injured. Stopping junctional bleeding is particularly challenging and requires the use of specifically designed junctional tourniquets. SAM® Junctional Tourniquet (SJT®, United States of America) and Tactical Abdominal Junctional Tourniquet (T-AJT®, Fora Group Türkiye) have been actively used by Turkish security forces. This study questioned the effect of training on combat medics' successful junctional tourniquet applications and application times (AT). METHODS: Our research on two different junctional tourniquet models was designed as a prospective randomized, crossover, single-blinded study. All 40 participants in the study were attendees of a 12-week combat medic training course with updated medical approvals, which were used as an eligibility criterion. Randomization was performed by drawing T-AJT®-SJT cards. The study consisted of pretraining and after-training tourniquet application phases. In each study phase, all participants' AT and the presence or absence of arterial flow were recorded for each group. Finally, the combat medics were presented with a 6-question survey. RESULTS: Although training increased successful T-AJT® application rates, training was not statistically significantly associated with successful applications for any tourniquet types (p>0.05). The pretraining phase ATs for SJT® and T-AJT® were 55±11.8 and 93.8±2.9 seconds, respectively, and the difference was statistically significantly different (p<0.001). Likewise, after-training phase ATs for SJT® and T-AJT® were 49±22.6 and 79.2±17.5 seconds, respectively, and participants' SJT® ATs were significantly shorter (p<0.001). Overall, when participants' applied any of the tourniquet unsuccessfully, the odds of participants' lower Visual Analogue Scale scores were 0.2 (95% CI [0.08, 0.49]. p<0.001). CONCLUSION: Our study basically investigates the effects of training on effective tourniquet application. Unfortunately, our after-training success rates remained unsatisfactory when compared to other studies. This is also the first study on T-AJT® tourniquet application, and further studies on its efficacy are also required.

Alpha-1 protease inhibitor and antichymotrypsin levels in acute pancreatitis.

BACKGROUND: Acute pancreatitis with high mortality of severe onset is still a major problem in medicine. Early identification of the severity of the disease is critical for effective treatment. Many markers have been tried and are still being tested. The ideal marker should be able to identify the cases and distinguish between mild and severe. METHODS: This prospective study included 34 cases (14 males, 20 females, mean age: 58 years) of acute pancreatitis and 33 cases (17 males, 16 females, mean age: 53 years) as a control group. Mild (n=29) and severe (n=5) cases were compared with respect to serum levels of amylase, C-reactive protein (CRP), alpha-1-protease inhibitor, and antichymotrypsin on admission and 24 and 48 hours (h) after admission. RESULTS: Alpha-1 protease inhibitor and antichymotrypsin levels were significantly elevated in the first 24 h; however, CRP peaked after 48 h in the acute pancreatitis group. While CRP showed significantly higher concentrations in patients with severe pancreatitis, alpha-1-protease inhibitor and antichymotrypsin levels changed slightly, but without significance, in severe cases. CONCLUSION: Alpha-1 protease inhibitor and antichymotrypsin are early events in acute pancreatitis, with high levels on admission. Activation of these variables declines after 24 h. These markers may have early diagnostic value in patients with acute pancreatitis. Because neither of them is good at discrimination of mild and severe cases in the disease, they should not be incorporated into routine clinical investigations.

Comparison of Weight Loss in Sleeve Gastrectomy Patients With and Without Antrectomy: a Prospective Randomized Study.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) restricts gastric volume to achieve weight loss. We aimed to compare the efficacy of LSG with and without antrectomy for achieving weight loss. METHODS: The prospective randomized study comprised 127 obese patients that underwent either LSG with antrectomy (2 cm to pylorus) (group 1) or LSG without antrectomy (6 cm to pylorus) (group 2), using 36 Fr and 32 Fr bougies, respectively. Patients were examined at 3-, 6-, 12-, and 24-month intervals for body mass index (BMI) measurements. RESULTS: Overall, 66 (51%) and 57 (49%) of patients were assigned to groups 1 and 2, respectively. The mean BMI of group 1 patients were 49.5 ± 8.01, 35.8 ± 5.40, 31.3 ± 4.9, 26.7 ± 4.02, and 22.9 ± 4.01 at the baseline, 3rd, 6th, 12th, and 24th month, respectively. The decreases in BMI were statistically significant. The mean BMI of group 2 patients were 46.7 ± 7.06, 39.3 ± 6.04, 32.4 ± 5.01, 26.6 ± 3.76, and 21.6 ± 3.70 at baseline, 3rd, 6th, 12th, and 24th month, respectively. The differences were also statistically significant. When compared with group 2, group 1 patients showed significantly lower BMI values on the 3rd month. Other differences were not statistically significant. CONCLUSION: LSG with or without antrectomy is safe and effective for weight loss. Larger studies are required to identify patients likely to benefit from LSG with antrectomy.

The Effectiveness and Feasibility of Laparoscopic Re-sleeve Gastrectomy.

BACKGROUND: Weight regain following laparoscopic sleeve gastrectomy (LSG) may be due to dilation of the gastric reservoir. Laparoscopic re-sleeve gastrectomy (LrSG) is among the revisional surgery options. OBJECTIVES: We aimed to investigate the effectiveness of LrSG for weight loss after a 12- and 24-month follow-up period. SETTING: Bariatric surgery center in Baku/Azerbaijan. METHOD: From June 2016 to June 2019, a total of 34 LSG patients with weight regain, underwent LrSG. We prospectively followed outcomes data were BMI changes, excessive weight loss, changes in laboratory values, and the presence of complications. RESULTS: The mean age at revision surgery was 36 ± 7.09 (range, 22-51) years, and the mean body mass index (BMI) before LrSG was 40 ± 5.2 kg/m2. The mean time between the primary and revision surgery was 50 ± 7.8 months. The main reasons for the revisions were weight regain and inadequate weight loss. The mean BMI value decrease at the 12th and 24th months were 27.7 ± 2 and 24.3 ± 1.02, which were statistically significant (p < 0.05). Analyses of hemoglobin A1C (A1C) values showed that the differences at the baseline, 12th and 24th months were statistically significant (95% 1.96 to 3.39, p < 0.001 and 95% CI 0.34 to 2.08, p = 0.005, respectively). CONCLUSIONS: In patients with weight regain or inadequate weight loss after LSG, LrSG may be a feasible and safe revisional procedure in a selected group of patients. Larger studies that compare other revisional surgery options (LRYGB, OAGB, duodenal switch, single anastomosis duodeno-ileal bypass) with LrSG are required.

Analysis of anatomical localization and severity of injury in patients with blood transfusion in urban terrain hospital.

BACKGROUND: Blood loss is the most significant cause of mortality in trauma cases. In injured patients, rapid evaluation and appropriate transfusion is lifesaving. The present study aims to analyze the blood/blood products requirement based on available data and find any associations between the transfusion requirements and injury severity scores (ISS) and anatomical locations of injuries of transfused patients. METHODS: Between 30 July 2014 and 30 July 2016, casualties admitted to the urban terrain hospital (UTH) and transfused at least one unit of red blood cell (RBC) were included. UTH Transfusion Record Notebook data included patients' age, mechanism and anatomical location(s) of the injury, admission hemoglobin (g/dL) level, injury severity score (ISS), transfused units of erythrocyte suspension (ES), warm fresh whole blood (WFWB), fresh frozen plasma (FFP), and massive transfusion (MT) rate. RESULTS: In this study, all patients were male; the mean age was 28.7±7.8 years. Overall, 59 of 579 (10%) patients were transfused 458 units of RBC (ES+WFWB). Torso (thorax ± abdomen) injury was present in 61% of the casualties who underwent transfusion, and 93% of these patients underwent massive transfusion. In 71% of patients, the ISS was >15, and there was statistically significant high blood/blood products use and MT rate in these patients, respectively (p=0.021, p=0.006). CONCLUSION: Anatomical location of injuries and ISS are valuable in the rapid determining of MT and survival rates of casualties. Especially in torso injuries, bleeding control is difficult and transfusion requirement and mortality rates are high. This study presents the trauma of urban terrain conflict-related transfusion data from a UTH.

Platelet-rich plasma as an additional therapeutic option for infected wounds with multi-drug resistant bacteria: in vitro antibacterial activity study.

PURPOSE: Infected wounds, such as diabetic foot infections, are mostly polymicrobial and microorganisms have high resistance rates to antimicrobials. Infected wounds in diabetic patients have high cost, morbidity, and mortality rates. Based on these facts, there is a need for supportive localized treatment options such as platelet-rich plasma (PRP) implementations. Demonstrating the in vitro antimicrobial effect, our aim was to lead up to clinical trials of localized PRP implementations in infected wounds such as diabetic foot infections. In this study, we aimed to demonstrate the in vitro antibacterial activity of PRP against methicilin-resistant Staphylococcus aureus (MRSA) and three more multi-drug resistant bacteria species that are important and hard-to-treat in wound infections. MATERIALS AND METHODS: In vitro antimicrobial activity of autologous PRP, platelet-poor plasma (PPP), and phosphate-buffered saline (PBS) on methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., extended spectrum beta lactamase producing Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa was compared by assessment of bacterial growth on agar plates and antimicrobial susceptibility test results. RESULTS: When compared to control group, PRP and PPP significantly suppressed bacterial growth of MRSA, K. pneumoniae, and P. aeruginosa at 1st, 2nd, 5th, and 10th hours of incubation (p < 0.05). VRE was the only bacteria that PRP and PPP showed limited activity against. When compared to PPP, PRP showed higher activity against MRSA, K. pneumoniae, and P. aeruginosa. However, the differences between PRP and PPP were statistically significant only against MRSA and P. aeruginosa at the first hour of incubation. CONCLUSIONS: Emerging PRP and other platelet-derived products seem to be promising alternative tools besides antibiotic treatment, debridement, negative pressure wound therapy, hyperbaric oxygen therapy, and other treatment options for treating diabetic foot infections.

Evaluating the effect of donor anxiety levels and lifestyle characteristics on the activation of platelet concentrates.

BACKGROUND: Smoking, alcohol use, performing regular physical exercise, dietary habits, and anxiety level may cause platelet activation. We aimed to evaluate the anxiety levels, smoking status, alcohol intake, and sportive habits of donors, and determine their impact on the quality of apheresis-platelets. METHODS: State and Transient Anxiety Inventory (STAI) was used to determine the level of donors' anxiety. STAI has two subscales: S-anxiety scale (STAI-I) and T-anxiety scale (STAI-II), each comprising 20 questions rated on a 4-point Likert scale. Data on smoking, alcohol consumption, and performing regular physical exercise were obtained from a questionnaire filled out before donation. Flow cytometric analysis was used to quantify activated platelets. RESULTS: The STAI-I level of 86 participants was normal, while that of 12 was higher. No significant difference was found in the active platelet absolute count [1.8×1011 (2.7) and 1.4×1011 (1.3), respectively; P=0.665] between donors with normal STAI-I levels and those with higher STAI-I levels. Of 98 donors, 42 had normal STAI-II levels, while 56 had higher STAI-II levels. No significant difference was found in the active platelet absolute count [2.3×1011 (3.1) and 1.5×1011 (2.3), respectively; P=0.224] between donors with normal STAI-II levels and those with higher STAI-II levels. Platelet counts of individuals who perform regular physical exercise were significantly higher than those of individuals who did not perform regular physical exercise (6.3±1.4×1011 vs. 5.5±1.4×1011). CONCLUSION: The quality of apheresis platelets is not affected by anxiety levels and lifestyle characteristics of blood donors. There is no need to organize apheresis blood donor pool considering with these subjects.

Bringing Packed Red Blood Cells to the Point of Combat Injury: Are We There Yet?

Objective: Hemorrhage is the leading cause of injury-related prehospital mortality. We investigated worst-case scenarios and possible requirements of the Turkish military. As we plan to use blood resources during casualty transport, the impact of transport-related mechanical stress on packed red blood cells (PRBCs) was analyzed. Materials and Methods: The in vitro experiment was performed in the environmental test laboratories of ASELSAN®. Operational vibrations of potential casualty transport mediums such as Sikorsky helicopters, Kirpi® armored vehicles, and the NATO vibration standard MIL-STD-810G software program were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (≤7 days) and 10 units of old (>7 days) PRBCs in a blood cooler box. The vibrations were simulated with a TDS v895 Medium-Force Shaker Device. On-site blood samples were analyzed at 0, 6, and 24 h for biochemical and biomechanical analyses. Results: The mean (±standard deviation) age of fresh and old PRBCs was 4.9±2.2 and 32.8±11.8 days, respectively. Six-hour mechanical damage of fresh PRBCs was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), and supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), and supernatant hemoglobin (p=0.015) were increased and hematocrit levels were decreased (p=0.015) within 6 h. Two (13%) units of fresh PRBCs and none of the old PRBCs were eligible for transfusion after 6 h of mechanical stress. Conclusion: When an austere combat environment was simulated for 24 h, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, the technology to overcome this mechanical damage does not seem to exist. In light of the above data, a new national project is being performed.

Publication rates of abstracts presented at the annual congress of the Turkish Society of Colorectal Surgery (years 2003-2011).

OBJECTIVE: The aim of our study is to examine the Publication Rate of Congress of Turkish Society of Colorectal Surgery meeting abstracts and determine the factors affecting publication rate. MATERIAL AND METHODS: All presentations at Congress of Turkish Society of Colorectal Surgery congresses held in 2003, 2007, 2009, 2011 were retrospectively assessed. Manuscripts indexed in Google-Scholar database were included. The meeting year, study type, presentation type, title and time to publication of studies were assessed. Actual impact factor values were assessed to introduce the scientific power of the journals. RESULTS: Among a total of 614 abstracts presented at these congresses, 139 (22.6%) presentations were published in various medical journals. The publication rate was higher in oral presentations as group compared to poster presentations (29.7% vs. 19.5%) (p<0.001). Mean time to publication period was 20.4 (±21.1) months. 78 (56.1%) of published articles were published in SCI-E journals while 61 (43.9%) were published in non-SCI-E journals. Experimental studies had a higher Publication Rate in analysis of publication rate according to study type (p<0.001). Prospective clinical studies had a higher publication rate than retrospective studies. The journals in which oral presentations had been published had greater impact factor than journals in which poster presentations had been published (p=0.02). If published; prospective clinical studies were published in journals with greater impact factor than retrospective studies (p=0.04). CONCLUSION: The quality of a meeting is correlated with the publication of abstracts accepted as presentations. Congress of Turkish Society of Colorectal Surgery congress is an efficient meeting for researchers, and have a lower PR as compared to international congresses while having a similar publication rate to equivalent scientific meetings. Being more selective during abstract acceptance should increase the Publication Rate and quality of Congress of Turkish Society of Colorectal Surgery congresses.

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin.

BACKGROUND: Intraabdominal adhesions remain a significant cause of morbidity and mortality. Moreover, intraabdominal adhesions can develop in more than 50% of abdominal operations. AIMS: We compared the anti-adhesive effects of two different agents on postoperative adhesion formation in a cecal abrasion model. STUDY DESIGN: Experimental animal study. METHODS: Forty Wistar albino type female rats were anesthetized and underwent laparotomy. Study groups comprised Sham, Control, Mitomycin-C, 4% Icodextrin, and Mitomycin-C +4% Icodextrin groups. Macroscopic and histopathological evaluations of adhesions were performed. RESULTS: The frequencies of moderate and severe adhesions were significantly higher in the control group than the other groups. The mitomycin-C and Mitomycin-C +4% Icodextrin groups were associated with significantly lower adhesion scores compared to the control group and 4% Icodextrin group scores (p=0.002 and p=0.008, respectively). The adhesion scores of the Mitomycin-C group were also significantly lower than those of the 4% Icodextrin group (p=0.008). CONCLUSION: Despite its potential for bone marrow toxicity, Mitomycin-C seems to effectively prevent adhesions. Further studies that prove an acceptable safety profile relating to this promising anti-adhesive agent are required before moving into clinical trials.

Generation of Platelet Microparticles after Cryopreservation of Apheresis Platelet Concentrates Contributes to Hemostatic Activity.

OBJECTIVE: In the last decade, substantial evidence has accumulated about the use of cryopreserved platelet concentrates, especially in trauma. However, little reference has been made in these studies to the morphological and functional changes of platelets. Recently platelets have been shown to be activated by cryopreservation processes and to undergo procoagulant membrane changes resulting in the generation of platelet-derived microparticles (PMPs), platelet degranulation, and release of platelet-derived growth factors (PDGFs). We assessed the viabilities and the PMP and PDGF levels of cryopreserved platelets, and their relation with thrombin generation. MATERIALS AND METHODS: Apheresis platelet concentrates (APCs) from 20 donors were stored for 1 day and cryopreserved with 6% dimethyl sulfoxide. Cryopreserved APCs were kept at -80 °C for 1 day. Thawed APCs (100 mL) were diluted with 20 mL of autologous plasma and specimens were analyzed for viabilities and PMPs by flow cytometry, for thrombin generation by calibrated automated thrombogram, and for PDGFs by enzyme-linked immunosorbent assay testing. RESULTS: The mean PMP and PDGF levels in freeze-thawed APCs were significantly higher (2763±399.4/µL vs. 319.9±80.5/µL, p<0.001 and 550.9±73.6 pg/mL vs. 96.5±49 pg/mL, p<0.001, respectively), but the viability rates were significantly lower (68.2±13.7% vs. 94±7.5%, p<.001) than those of fresh APCs. The mean endogenous thrombin potential (ETP) of freeze-thawed APCs was significantly higher than that of the fresh APCs (3406.1±430.4 nM.min vs. 2757.6±485.7 nM.min, p<0.001). Moreover, there was a significant positive poor correlation between ETP levels and PMP levels (r=0.192, p=0.014). CONCLUSION: Our results showed that, after cryopreservation, while levels of PMPs were increasing, significantly higher and earlier thrombin formation was occurring in the samples analyzed despite the significant decrease in viability. Considering the damage caused by the freezing process and the scarcity of evidence for their in vivo superiority, frozen platelets should be considered for use in austere environments, reserving fresh platelets for prophylactic use in blood banks.

An unusual complication of the use of stapler after Hartmann's procedure.

BACKGROUND: Circular anastomotic staplers have been used in colorectal surgery for several years with low complication rates. We report here an extremely rare case of direct colovaginal anastomosis and rectovaginal fistula occurred by using a 31 end-to-end anastomosis stapler after reversal of Hartmann's Procedure. STUDY DESIGN: A 33-year-old woman with complaint of rectal bleeding had undergone low anterior resection and end colostomy for rectal adenocarcinoma in 1995. In spite of making recommendation for colostomy closure, she had postponed the operation until 2003 due to afraid of incontinence. After reversal of Hartmann's procedure achieved by using circular stapler and diverting ileostomy, she developed complaints of vaginal gas and minimal vaginal fecal discharge. RESULT: Endoscopic examination and imaging methods revealed a rectovaginal fistula with a blind Hartmann's pouch. After a certain verification of complexity of the case, a reoperation which comprises true intestinal anastomosis and repair of fistula was performed. Postoperative period was uneventful except an incisional infection, and ileostomy was closed subsequently. CONCLUSION: A rectovaginal fistula, though encountered rarely, must be taken into account in cases with suspicious complaints after using circular stapler for pelvic intestinal anastomosis. Careful placement of stapler in accurate direction has a great importance to avoid stapling related complications.

Comparison of the effects of Mitomycin-C and sodium hyaluronate/carboxymethylcellulose [NH/CMC] (Seprafilm) on abdominal adhesions.

INTRODUCTION: Intra-abdominal adhesions (IA) may occur after abdominal surgery and also may lead to complications such as infertility, intestinal obstruction and chronic pain. The aim of this study was to compare the effects of Mitomycin-C (MM-C) and sodium hyaluronate/carboxymethylcellulose [NH/CMC] on abdominal adhesions in a cecal abrasion model and to investigate the toxicity of MM-C on complete blood count (CBC) and bone marrow analyses. METHODS: The study comprised forty rats in four groups (Control, Sham, Cecal abrasion + MM-C, and Cecal abrasion + NH/CMC). On postoperative day 21, all rats except for the control (CBC + femur resection) group, were sacrificed. Macroscopical and histopathological evaluations of abdominal adhesions were performed. In order to elucidate the side effects of MM-C; CBC analyses and femur resections were performed to examine bone marrow cellularity. RESULTS: CBC analyses and bone marrow cellularity assessment revealed no statistically significant differences between MM-C, NH/CMC and control groups. No significant differences in inflammation scores were observed between the groups. The MM-C group had significantly lower fibrosis scores compared to the NH/CMC and sham groups. Although the adhesion scores were lower in the MM-C group, the differences were not statistically significant. CONCLUSION: Despite its potential for systemic toxicity, MM-C may show some anti-fibrosis and anti-adhesive effects. MM-C is a promising agent for the prevention of IAs, and as such, further trials are warranted to study efficacy.