Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

BACKGROUND: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. METHODS: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. RESULTS: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. CONCLUSIONS: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Rumen bacteria at work: bioaugmentation strategies to enhance biogas production from cow manure.

AIMS: To investigate the effects of different bioaugmentation strategies for enhancing the biogas production from cow manure and evaluate microbial community patterns. METHODS AND RESULTS: Co-inoculation with cow rumen fluid and cow rumen-derived enriched microbial consortia was evaluated in anaerobic batch tests at 36°C and 41°C. Singular addition of both rumen fluid and enriched bioaugmentation culture had a promising enhancement on methane yields; however, the highest methane yield (311 ml CH4 per gram VS at 41°C) was achieved when the anaerobic seed sludge was co-inoculated together with rumen fluid and enriched bioaugmentation culture. Bacterial community profiles were investigated by Ion PGM Platform, and specific lignocellulolytic bacteria dynamics in batch tests were assessed by qPCR. The temperature had minor effects on the abundance of bacterial community; in which Bacteroidetes and Firmicutes were the most abundant phyla in all digesters. Furthermore, Rikenellaceae, Clostridiaceae, Porphyromonadaceae, Bacteroidaceae and Ruminococcaceae played a crucial role during the anaerobic degradation of cow manure. There was an important impact of Firmicutes flavefaciens and Ruminococcus albus at 41°C, which in turn positively affected the methane production. CONCLUSION: The degree of enhancement in biogas production can be upgraded by the co-inoculation of rumen-derived bioaugmentation culture with anaerobic seed sludge with high methanogenic activity. SIGNIFICANCE AND IMPACT OF THE STUDY: A close look at the biotic interactions and their associations with abiotic factors might be valuable for evaluating rumen-related bioaugmentation applications.

Pancreas transplantation: experience of single center.

BACKGROUND: Diabetes is the most common cause of renal failure. In patients with type I diabetes and renal failure,dialysis and insulin therapy can prevent a clinical context that causes rapid death, but they are insufficient to prevent longterm complications. Pancreas and islet cell transplantation inpatients with type I diabetes are the only curative treatment and have recently become more common. METHODS: Between December 2006 and August 2010 a total of 10 patients underwent pancreas transplantation. The patient's data were analysed retrospectively. RESULTS: 10 patients and their data were included in this study. Six patients were male and 4 patients were female. All patients are still alive, with functional grafts. CONCLUSIONS: Pancreas transplantation is the most effective treatment for patients with type I DM. This paper discusses the feasibility of this process and presents the experience of Ankara University in pancreas transplantation.

Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions.

BACKGROUND/PURPOSE: Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model. METHODS: Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems. RESULTS: All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used. CONCLUSIONS: Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

Single-port laparoscopic surgery by use of a surgical glove port: initial experience with 25 cases.

BACKGROUND: single-port laparoscopic surgery has gained popularity over the last decade. This technique is used for several surgical procedures. This paper documents a new and cheaper access method known as "surgical glove port" or "homemade single-port", and describes our initial experience with 25 cases. METHOD: Eleven cholecystectomies, eight totally extraperitoneal inguinal hernia repairs, three splenectomies, two gastric wedge resections, and one anti-reflux procedure were performed. RESULTS: Twenty-four procedures out of twenty-five were completed without conversion to open or multiple port techniques. An individual patient who had both cholelithiasis and gastrointestinal stromal tumor underwent both cholecystectomy and gastric wedge resection in the same session with surgical glove port technique. In another case two additional 5-mm incisions were made for hemostasis. The additional operation was required and performed by using surgical glove port for a hiatal hernia repair case, because of postoperative hemorrhage. CONCLUSION: Single-port laparoscopic surgery is an applicable technique for plenty of surgical procedures. Also, surgical glove port is a newer technique and some initial experience shave already published all over the world. Surgical glove port has advantages such as cost-effectiveness, easy and safe port implantation and specimen extraction. SGP can also be used for treating post-operative complications.

Helminth infections of wild boars (Sus scrofa) in the Bursa province of Turkey.

The present study aimed to investigate the status of helminth infections in wild boars in the Bursa province of Turkey. For this purpose, during 2007-2008, 27 wild boars were necropsied and examined for helminths. Individual samples of tongue and diaphragm from 27 necropsied wild boars and an additional 22 tongue and diaphragm samples provided by hunters were examined by trichinoscopy and artificial digestion for Trichinella spp. larvae. Twenty animals (74%) were identified as being infected with at least one helminth species. Twelve species of helminths were detected, with the following prevalence rates: Metastrongylus apri (59%), Metastrongylus salmi (52%), Metastrongylus pudendotectus (52%), Dicrocoelium dendriticum (33%), Globocephalus urosubulatus (22%), Macracanthorhynchus hirudinaceus (19%), Gongylonema pulchrum (11%), Physocephalus sexalatus (7%), Trichuris suis (7%), Ascarops strongylina (4%), Hyostrongylus rubidus (4%) and Taenia hydatigena larvae (4%). Generally, lungworms were the predominant helminths. The highest mean abundance was observed for M. pudendotectus, and the lowest was determined for T. hydatigena larvae. Significant differences in the prevalence and intensity were found for D. dendriticum with respect to host age and sex, respectively. The mean intensity of M. pudendotectus was significantly influenced by the sex and age of the wild boars. This study is the first report describing the presence of M. salmi, M. pudendotectus, D. dendriticum, G. urosubulatus, M. hirudinaceus, P. sexalatus, A. strongylina and H. rubidus in wild boars in Turkey. All analysed muscle samples were negative for Trichinella spp. larvae.

Identification of post-transplant lymphocele using lymphatic mapping with isosulphane blue.

Lymphocele development after renal transplantation is a well-recognized complication that occurs with the incidence of 0.6-18%. Although the majority of patients are asymptomatic, post-renal transplant lymphocele continues to be a major cause of morbidity if it is left untreated. The standard approach for the treatment of symptomatic lymphoceles is accepted to be laparoscopic or open marsupialization in many centers if simple drainage and conservative measures fail. However, marsupialization is almost impossible under certain circumstances, such as in the case of excessive abdominal adhesions. Hence, direct visualization of the lymphatic leak and suture ligation may become inevitable, which is usually a challenging procedure for the surgeon. Herein we report a case of post-renal transplant lymphocele treated by the direct identification and suture ligation of injured lymphatic vessel using a new method similar to sentinel lymph node detection using the dye isosulphane blue.

Occlusion of the celiac trunk, the inferior mesenteric artery and stenosis of the superior mesenteric artery in peripheral thrombangiitis obliterans.

Buerger's disease is an inflammatory occlusive disease which commonly involves medium-sized or smaller vessels of extremities. Mesenteric involvement in Buerger's disease is very rare. It can occur at any time during the course of the disease and presents with acute mesenteric ischaemia. In this study, a case of Buerger's disease with mesenteric involvement diagnosed before the onset of acute mesenteric ischaemia and managed endovascularly is reported.

Brain Death and Organ Donation: Knowledge, Awareness, and Attitudes of Medical, Law, Divinity, Nursing, and Communication Students.

BACKGROUND: Throughout the world, there is a shortage of suitable organs for organ transplantation. The aim of this study was to assess the level of knowledge, awareness, and attitudes of medical, law, divinity, nursing, and communication students, who will be involved in this issue in the future, regarding brain death and organ donation. METHODS: Data were collected with the use of a 30-item questionnaire. RESULTS: Of the 341 participants, 228 (66.8%) were female and overall average age was 21.6 ± 2.8 years. Nearly one-half of them (51.3%), especially nursing and medical students, wanted to be a donor, but only 2% had an organ donation card; 78.3% emphasized that family must have the right to make the decision for organ donation, and the vast majority of the participants considered that the organs could not be taken without any permission. Kidney and heart were the most commonly identified transplantable organs; the less frequently known organ was intestine. Only 71 participants, most of them medical, divinity, and law students, correctly answered all questions about brain death; 68.6% stated that organ donation is allowed by religion, and 5% expressed that it is religiously forbidden; 37.3% did not have confidence in health care policy. Law students were more confident, nursing students less confident. CONCLUSIONS: Better understanding of organ donation and concepts by the doctors, nurses, legislators, religious officials, and mass communications professionals who will give direction to society's behaviors and beliefs would help to spread positive attitudes toward organ donation and transplantation in the public.

Studies on chemotherapy of parasitic helminths: efficacy of artemether on Japanese strain of Schistosoma japonicum in mice.

Effects of artemether were examined on Schistosoma japonicum in mice. When the drug was given at a daily dosage of 200 mg/kg for 4 successive days from 46 days post-infection, a significant reduction in worm recovery was observed. A significant reduction in size of worms from the medicated mice was also seen compared with that from non-medicated controls.

Nephron-sparing surgery for renal cell carcinoma of the allograft after renal transplantation: report of two cases.

The risk of renal transplanation patients developing de novo malignancy is increased 100-fold compared with the healthy nontransplantation population. Renal cell carcinoma (RCC) arising from native kidneys is diagnosed among up to 4.6% of the renal transplant recipients as a consequence of immunosuppression. These tumors tend to behave more aggressively.(1) Although tumors occurring in allografted kidneys can be treated by partial (to save functional graft) or total nephrectomy, there is a paucity of data the outcomes. From 1978 to 2012, we performed 804 kidney transplantations including two cases in which RCC arose from the allografted kidney, both of which were treated with nephron-sparing surgery. The first patient has been followed for 30 months with a well functioning graft without an RCC recurrence. The second patient has returned to dialysis after 6 months due to an insufficient remnant nephron mass. In conclusion, nephron-sparing surgery is a novel alternative to total nephrectomy for allograft RCC. The remaining kidney can preserve function and the patient may not need chronic dialysis.

Investigations on the seasonal patterns of strongyle infections in grazing lambs, and the occurrence of anthelmintic resistance on sheep and goat farms in western Anatolia, Turkey.

The seasonal patterns of strongyle infections in untreated, weaned lambs were determined on four governmental farms during a grazing season. In three farms, the infection level (predominantly Teladorsagia spp. and Trichostrongylus spp.) measured by egg counts or worm burdens remained low throughout the study; higher egg counts mainly caused by Haemonchus contortus were transiently recorded on the fourth farm. Significant body weight gains were observed in all groups, but they varied between farms irrespective of the level of strongyle infections, suggesting that the economic effectiveness of anthelmintic treatments of weaned lambs is doubtful under the extensive grazing conditions and the hot, dry climate in the region. In the second part of the study, faecal egg count reduction tests were performed for albendazole, thiabendazole, tetramisole and ivermectin on 12 sheep and goat farms to provide first information on anthelmintic resistance in trichostrongyles of small ruminants in Turkey. There was no hint of benzimidazole resistance, and unequivocal evidence of ivermectin resistance was missing. In contrast, tetramisole resistance was detected on one sheep farm.

Epidemiology of Toxocara vitulorum in cattle around Bursa, Turkey.

The prevalence of Toxocara vitulorum in cattle around Bursa, Turkey, was surveyed by faecal examination of eggs. The average infection rate among 11 towns was 5.1% in calves younger than 6-months-old, and 2.2% in all ages of animals. T. vitulorum was found to be prevalent in two different areas of Bursa. Third stage larvae were found in one milk sample and therefore galactogenic transmission was suggested. Experimental incubation of eggs showed that the optimum temperature for development was 20 to 30 degrees C and eggs could survive under low temperature, indicating that grazing in the contaminated pasture may accelerate the transmission of eggs to cows. Mode of farming, therefore, affects the infection rate of T. vitulorum and may explain the difference in the rate between the two areas.

Effects of mebendazole on Angiostrongylus costaricensis in mice, with special reference to the timing of treatment.

Mebendazole was given to mice infected with Angiostrongylus costaricensis at a single dose of 5 mg/kg at 6, 11, 16 or 21 days post-infection (p.i.) and in five successive doses at 5 mg/kg daily at 6, 11 or 16 days p.i. The effects were comparatively assessed by examining various parameters in host mice and worms. As a whole, the effects of mebendazole were caused more conspicuously by five successive treatments than by a single treatment. In both treatment modalities, the effects were more remarkable in earlier treatments, and nearly complete effects were caused by five successive treatments before 15 days p.i. These results suggest that the inhibition of egg formation and/or oviposition will inhibit the pathological changes caused in the disease by A. costaricensis, especially before the onset of the changes.

[Is seat belt sign a predictor for physicians in management of trauma patients in emergency settings?]. / Acil servis travma hastalarinda "emniyet kemeri izi" tedaviyi belirleyici bir klinik bulgu mudur?

Seat belt sign (SBS) is frequently seen as a clinical finding in motor vehicle accidents. The purpose of this study is to determine the diagnostic value of SBS. All adult patients presenting with an history of motor vehicle accident to a tertiary care university hospital emergency department was included in this prospective, observational study covered the time period between July 01, 1999 and February 01, 2000. 213 patients were included in this study; 135 (63.4%) were male, and 76 patients (35.7%) were seat-belted. SBS was seen on 27 (35.5%) belted patients. Fourteen of seat-belted had rib fractures nine of those patients with rib fractures were found to have SBS. There was a statistically significant difference between the patient groups with or without SBS in rib fractures (p = 0.0128) While no significant differences were detected between groups regarding the frequency of intra-cranial, intra-thoracic, intra-abdominal and extremity injuries three of four patients who had sternum and clavicular fractures took place in SBS(+) group (p = 0.090). The presence of SBS in trauma patients may create a high index of suspicion for thoracic injuries, especially for rib fractures. It is widely accepted that any delay in the diagnosis may increase morbidity and mortality following thoracic injuries. Further studies are needed to investigate the possible role of SBS in the prediction of the severity of injuries following thoracic trauma.