Synergistic effects of hyperbaric oxygen and granulocytecolony stimulating factor on postoperative adhesion formation in a rat cecal abrasion model.

PURPOSE: We investigated the synergistic effect of hyperbaric oxygen (HBO) and granulocyte-colony stimulating factor (G-CSF) on adhesion formation in rats. METHODS: 40 adult male Sprague-Dawley rats (250-350 g) were divided into 4 groups. In group-1, no further management was undertaken. Group-2 received HBO therapy, group-3 was treated with 50 ug/kg subcutaneous G-CSF once daily for 7 days following laparatomy and cecal abrasion and group-4 was given both G-CSF and HBO therapies. On the 7th day, all rats were sacrificed and adhesions were scored. Tissue samples from adhesions and peritonea and cecum wall were examined both pathologically and biochemically for tissue hydroxyproline content. RESULTS: No mortality occurred in study groups. When the groups were evaluated according to the adhesion numbers and grades, there was a statistically significant difference between the control and groups 3 and 4 (P < 0.001). There was no statistically significant difference between groups 1 and 2 (p > 0.05). HBO + G-CSF group was significantly different from control, HBO and G-CSF groups, regarding hydroxyproline contents (p = 0.005). Inflammation and fibrosis did not differ significantly among the groups (p = 0.248), (p = 0.213). CONCLUSION: HBO treatment could not reduce the adhesion formation alone. Combined use of HBO and G-CSF, has a markedly preventive effect on postoperative adhesion formation (Tab. 1, Fig. 2, Ref. 57).

Preoperative administration of oral carbohydrate-rich solutions: Comparison of glucometabolic responses and tolerability between patients with and without insulin resistance.

OBJECTIVE: Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR. METHODS: Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated. RESULTS: Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups. CONCLUSION: Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.

Can D-dimer become a new diagnostic parameter for acute appendicitis?

INTRODUCTION: In this study, we investigated D-dimer serum level as a diagnostic parameter for acute appendicitis. MATERIALS AND METHODS: Forty-nine patients were enrolled in the study. Patients were classified according to age; sex; duration between the beginning of pain and referral to a hospital or clinic; Alvarado scores; and in physical examination, presence of muscular defense, the number of leukocytes, preoperative ultrasonography, and D-dimer levels of histopathologic study groups were analyzed. RESULTS: Of the patients enrolled in the study, 26.5% were females and 73.5% males. The average age was 21 years (range, 16-38 years) and 81.7% acute appendicitis (AA). According the duration of pain, 63.2% of the patients were referred to the hospital within the first 24 hours, 26.5% of the patients were referred to the hospital within 24 to 48 hours, and 10.3% were referred to the hospital within a period of more than 48 hours. No statistically significant difference was determined regarding D-dimer levels between the histopathologic study groups (P > .05). Alvarado scores lower than 7 were found in 36.7% and 7 or higher in 63.3% of the patients. There was no statistically significant difference related with D-dimer levels between histopathologic study groups (P > .05). The ratio of cases with a number of leukocytes below the upper limit were determined respectively as 32.7% and 67.3%, and no statistically significant difference was found regarding d-dimer levels between histopathologic study groups (P > .05). CONCLUSION: Increased D-dimer levels should not be considered as a diagnostic parameter in diagnosis of acute appendicitis.

The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis.

PURPOSE: Acute appendicitis is one of the most common surgical emergencies. Diagnosis is usually made depending on the presenting history, clinical evaluation, and laboratory tests. The aim of this study was to investigate the role of urinary 5-hydroxyindoleacetic acid (U-5-HIAA) in the early diagnosis of acute appendicitis. METHODS: Thirty-five pigmented male rabbits were divided into 5 groups. Group 1 is the control (n = 7); group 2 is the sham (n = 10). The appendix was ligated from its base, and an appendectomy was performed after 12, 24, 36 hours in group 3 (n = 7), group 4 (n = 7), and group 5 (n = 7), respectively. Spot urine samples were obtained for U-5-HIAA determination, and appendectomy tissues were examined histopathologically. RESULTS: Acute appendicitis was diagnosed in all animals in group 3, group 4, and group 5, and the mean levels of U-5-HIAA in group 3 were higher than in the other groups. The mean of U-5-HIAA levels between animals with appendicitis and those without showed a significant difference (P = .003). The U-5-HIAA cutoff point of 4.15 mg/g creatinine had a sensitivity of 85%, a specificity of 64.29%, and an accuracy of 76% (area under curve = 0.805) for acute appendicitis. The probability of acute appendicitis is found to be 10, 2 times more when the U-5-HIAA level is greater than 4.15 mg/g creatinine. CONCLUSION: We have concluded that spot U-5-HIAA level increases significantly in the early stages of acute appendicitis.

Management and mid- to long-term results of early referred bile duct injuries during laparoscopic cholecystectomy.

BACKGROUND/AIMS: Bile duct injuries (BDI) usually need operative repair and remain as a challenge even for surgeons who specialize in hepatobiliary surgery. The objective of this study was to define the presentation, in-hospital management, and mid- to long-term outcome of BDIs during laparoscopic cholecystectomy (LC) referred to a tertiary center in their early period. METHODOLOGY: From January 1996 to January 2006, 31 patients with BDI sustained during or after LC were treated at our institution. Patients were referred to our center from 18 community hospitals in their first 15 postoperative days. Patients' charts were retrospectively reviewed; presentation, management, and follow-up details recorded at the primary hospitals and at our institution were documented. RESULTS: There were 5 patients with type-A and one with type-C injury, according to Strasberg classification. The remainders had a major BDI. The mean time to referral was 3.45 (median 2) days. Treatment methods chosen after referral were as follows: drainage-observation in 2 patients (6.5%), nasobiliary drainage in 4 (12.9%), endoscopic sphincterotomy plus biliary stenting in 1 (3.2%), and surgical intervention (duct-to-duct anastomosis or biliary-enteric reconstruction) in 24 patients (77.4%). Although a success rate of 83.3% was achieved in the early period, 10 patients (32.3%) had late postoperative complications (stricture and cholangitis), and of these, 3 required endoscopic stent placement, and 7 patients underwent a biliary diversion with Roux-en-Y Hepaticojejunostomy. One out of 24 patients with long-term follow-up developed biliary cirrhosis, and one patient with malignancy expired. CONCLUSIONS: Minor BDIs can be satisfactorily treated with endoscopic interventions. Extended lateral injuries, complete CBD transsections, and long segment stenosis usually require surgical therapy. Duct-to-duct anastomosis may be an option as the first-line therapy in selected patients after early referral, though many patients eventually require a Roux-en-Y hepaticojejunostomy.

The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery.

AIM: To determine the effect of preoperative skin preparation procedures performed by nurses on postoperative surgical site infection in abdominal surgery. BACKGROUND: Despite all interventions, postoperative SSIs still greatly affect mortality and morbidity. DESIGN: This is an experimental study. METHODS: Procedures developed for nurse application of preoperative skin preparations were tested on a control group (n = 39) and study group (n = 43). RESULTS: Only clinical routines for preoperative skin preparation were performed on the control group patients. Control group members' skins were mostly prepared by shaving with a razor blade (41%). For the study group members, the researchers used the preoperative skin preparation procedure. Clippers were used to prepare 55.8% of study group members while 44.2% of them were not treated with the clipper because their wounds were clean. As a requirement of the procedure, all members of the study group had a chlorhexidine bath at least twice after being hospitalised and at least once a night before the operation under controlled conditions. In the group where chlorhexidine bath was not applied, the infection risk was found to be 4.76 times (95%CI = 1.20-18.83) greater even after corrections for age and gender had been made. The difference between control group and study group with respect to surgical site infections was also statistically significant (p < 0.05). CONCLUSION: Preoperative skin preparation using clipper on the nights before an operation and a 50 ml chlorhexidine bath excluding head area taken twice in the pre-operative period are useful to reduce SSI during postoperative period. RELEVANCE TO CLINICAL PRACTICE: We find that preoperative skin preparation using the procedures developed as a result of findings of this study is useful in reducing surgical site infection during the postoperative period.

Does the type of resuscitative fluid affect healing of colonic anastomosis in experimentally induced hemorrhagic shock in rats?

OBJECTIVE: The aim of the study was to investigate the effects of different resuscitative fluids on the healing of intestinal anastomosis in a hemorrhagic-shock rat model. MATERIALS AND METHODS: Closed-colony Wistar male rats (n = 40; 8 rats per group) were subjected to volume-controlled hemorrhagic shock, followed by a 30-min shock phase. The animals were then resuscitated with one of the following fluids (which also corresponds to their respective groups): lactated Ringer's solution (LR), hydroxyethyl starch (HES), 7.5% hypertonic saline (HS) and autologous blood (AB). There was also a control group (CL), which did not experience hemorrhagic shock or receive any resuscitative fluids. All rats underwent laparotomy, segmental resection and anastomosis of the left colon. Five days later, a 2nd laparotomy was performed and the anastomotic bursting pressure was measured in vivo. Thereafter, the anastomosed segment was resected to measure the tissue hydroxyproline level and the grade of anastomotic fibrosis. RESULTS: All experimental groups (LR, HES, HS and AB) exhibited lower anastomotic bursting pressures than the CL group; however, no intergroup differences achieved statistical significance. The mean tissue hydroxyproline level and fibrosis grade also were similar across all 5 groups. CONCLUSION: In traumatic hemorrhagic shock, anastomosis safety does not appear to be affected by the type of fluid used for resuscitation. Moreover, LR, HES and HS all seemed to reinforce healing as effectively as transfused blood.

Effects of preoperative carbohydrate loading on glucose metabolism and gastric contents in patients undergoing moderate surgery: a randomized, controlled trial.

OBJECTIVE: Despite contrary evidence, the practice of overnight fasting before elective surgery maintains its place in tradition. However, prolonged starvation, by its catabolic action, may increase the detrimental effects of surgery. In this study, we evaluated the effects of preoperative carbohydrate loading on the gastric contents of patients and perioperative metabolism. METHODS: Seventy patients scheduled for cholecystectomy or thyroidectomy randomly were assigned to the treatment or control group. Patients in the treatment group (n = 34) received 800 mL of a carbohydrate-rich fluid on the evening before surgery and 400 mL of the same fluid 2 h preoperatively. Conversely, control patients (n = 36) underwent overnight fasting. Plasma glucose and serum insulin levels were obtained across the perioperative period and during anesthesia induction. The volume and pH of preoperative residual gastric contents also were measured. RESULTS: Preoperative plasma glucose levels were found to remain significantly higher in patients who had received the carbohydrate-rich fluid. Serum insulin levels that were elevated initially in the study group returned to control levels by the time of anesthesia induction. There was no statistical difference between the two groups with respect to gastric residue contents or gastric fluid pH. CONCLUSION: The preoperative intake of carbohydrate-rich fluids does not appear to alter the amount or pH of gastric contents, suggesting that this is a safe procedure, in terms of aspiration risk. Furthermore, the intake of such fluid might prevent energy malnutrition.

Lightning strike: an unusual etiology of gastric perforation.

Lightning strike is an unusual form of trauma in terms of being one of the leading causes of death from natural phenomenon. Lightning strike can cause severe damage to many systems and results in a high mortality. The most common cause of death in the lightning strike victim is cardiopulmonary arrest. The most vulnerable subjects for lightning strike are individuals who work in open fields, farmers, and swimmers. The cardiac and neurological injuries are the most serious injuries. Burns, tinnitus, blindness, and secondary blunt trauma have also been reported. Gastrointestinal complications have been documented very rarely. In this study, we present a case of gastric perforation after lightning strike. No report related to gastric perforation caused by lightning strike has been identified in the literature.

A comparison of different hemorrhoidectomy procedures.

OBJECTIVE: To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel (HS) and classical methods. METHODS: Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS (n=22), closed HS (n=22), Miligan Morgan (n=22), and Ferguson (n=21) hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. RESULTS: Bleeding volume was significantly lower in Groups I-II (p<0.001). Operation time was significantly shorter in Group I (p<0.001). Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III (p<0.001) compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III (p<0.004). Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV (p<0.001). Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III (p<0.007) and similar in closed hemorrhoidectomy group. CONCLUSION: The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain.

Stump appendicitis, rare complication after appendectomy: report of a case.

Appendectomy is one of the most common procedures in surgical practice. Stump appendicitis is an acute inflammation of the residual part of the appendix and a rare complication of incomplete appendectomy. It may present clinically as acute abdomen. We report a case of stump appendicitis 12 years after open appendectomy. After the diagnosis of acute appendicitis, the patient was operated and discharged from the hospital four days after operation without any complications. Stump appendicitis is a rare cause of acute abdomen and should be taken into consideration in the differential diagnosis.

Extracapsular extension is associated with increased ratio of metastatic to examined lymph nodes in axillary node-positive breast cancer.

BACKGROUND: Extracapsular extension of nodal tumor cells, although it is not a parameter of staging, has recently been shown to be correlated with the high number of metastatic lymph nodes in patients with axillary-positive breast cancer. It is suggested that the use of involved/examined lymph node ratio instead of the number of metastatic lymph nodes in axillary evaluation would obtain standardized prognostic data for patient management. This study investigated the association of the extracapsular extension with the lymph node ratio in a node-positive group of patients. PATIENTS AND METHODS: Medical records of 170 patients with positive axillary status were retrospectively reviewed. Of these, 54 were extracapsular extension positive, and the remaining were extracapsular extension negative. A comparison was made between extracapsular extension-positive and extracapsular extension-negative groups with respect to some potential prognostic indicators. RESULTS: Number of metastatic lymph nodes, number of examined lymph nodes, and involved/examined lymph node ratio were found to be significantly higher in patients with a presence of extracapsular extension. CONCLUSION: The results suggest that the presence of extracapsular extension might force physicians to perform more aggressive adjuvant therapies and that the extracapsular extension could be a valuable parameter in the management of breast cancer because it has a strong relationship with the proven prognostic factors.

Accurate positioning of the 24-hour pH monitoring catheter: agreement between manometry and pH step-up method in two patient positions.

AIM: To investigate the agreement between esophageal manometry and pH step-up method in two different patient positions. METHODS: Eighteen subjects were included in the study. First, the distance from the nose to the proximal border of the lower esophageal sphincter (LES) was measured manometrically. Then a different investigator, who was blinded to the results of the first study, measured the same distance using the pH step-up method, with the patient in both upright and supine positions. An assessment of agreement between the two techniques was performed. RESULTS: In the supine position, the measurement of only one subject was outside the range accepted for correct positioning (< or = 3 cm distal or proximal to the LES). In the upright position, errors in measurement were recognized in five subjects. Bland-Altman plots revealed good agreement between measurements obtained manometrically and by the pH-step up method with the patient in the supine position. CONCLUSION: In the case of nonavailability of manometric detection device, the pH step-up method can facilitate the positioning of the 24 h pH monitoring catheter with the patient in the supine position. This should increase the use of pH-metry in clinical practice for subjects with suspected gastroesophageal reflux disease if our results are supported by further studies.

Appropriate approach to bronchobiliary fistulas: a case series with hydatid disease and algorithm of case-based management.

Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complication of hydatid disease. Optimal management of cases is crucially important in establishing rapid recovery and avoiding additional complications. The use of an algorithmic guide is essential because of an ongoing dilemma that involves a large variety of therapeutic options. We present four patients with bronchobiliary fistulas caused by liver hydatid disease to discuss the management of therapeutic options through a case-based approach and an extent review to finally generate an algorithm. In this series, two patients were treated surgically, and the remaining were treated with conservative methods. To date, they have developed neither recurrence nor need for additional intervention. Although treatment of bronchobiliary fistulas is traditionally thought to be surgical, most of the less severe cases can be treated nonoperatively. Making an accurate selection among less invasive methods and/or open surgical interventions seems to be a key component of management.

The factors affecting length of stay of the patients undergoing appendectomy surgery in a military teaching hospital.

The principal objectives of this study were to identify the main predictors of the length of postoperative hospital stay for patients undergoing appendectomy in a military training hospital in Turkey, to examine the effects of each significant predictor, and to justify to hospital health care managers the reasons why an increase in effective use of hospital utilization resources is needed and so important. This study gives the results of a 2-year retrospective study conducted at Gulhane Military Medical Academy between January 2003 and January 2005. The medical files of 417 patients undergoing appendectomy during this 2-year period were reviewed. A number of demographic and clinical patient characteristics were examined to determine their significance in lengthening the post-operative and total hospital stay. After taking all demographic and clinical patient characteristics into account, it was determined that those patients who were temporary or short-term service members and whose medical complications were more severe were more likely to stay in the hospital for longer periods. Despite its limitations, the study reveals that factors affecting variations in resource utilization can be minimized by following very simple administrative procedures. Furthermore, the results could increase awareness among hospital managers of the significant factors involved for health care providers in modifying their behavior concerning resource utilization decisions.

Preoperative and postoperative administration of hyperbaric oxygen improves biochemical and mechanical parameters on ischemic and normal colonic anastomoses.

Colonic anastomotic leaks are a major postoperative complication, causing increased mortality and morbidity. Tissue ischemia is one of the most important factors that disrupt anastomotic healing. It is possible to reverse inadequate tissue oxygenation by using increased atmospheric pressure and hyperoxia, which are obtained from hyperbaric oxygen treatment (HBO). Our aim was to investigate the effects of preoperative and postoperative HBO treatment on normal and ischemic colonic anastomoses in rats. Eighty male Wistar Albino rats, weighing between 180 and 240 g, were divided into 8 equal groups. A 1-cm segment of left colon was resected 3 cm proximal to the peritoneal reflection in all groups and colonic anastomosis was performed. In groups 2, 4, 6 and 8, colonic ischemia was established by ligating 2 cm of mesocolon on either side of the anastomosis. Control groups (1 and 2) received no HBO. HBO treatment was given preoperatively in groups 3 and 4, postoperatively in groups 5 and 6, and both preoperatively and postoperatively in groups 7 and 8. HBO treatment was applied for 2 days in the preoperative period and 4 days in the postoperative period. Relaparotomy was performed on postoperative day 5 and a perianastomotic colon segment 2 cm in length was excised for detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. HBO treatment increased tissue hydroxyproline levels in all groups, and this difference was significant in normal anastomosis groups receiving preoperative HBO compared to controls (p = .013 for group 1 vs. group 3; p = .023 for group 1 vs. group 5). This improvement was more evident in ischemic and normal groups treated by administration of combined pre- and postoperative HBO (p = .021 and p = .013). HBO treatment also increased the mean bursting pressure values in all groups, and again, a statistically significant increase was noted in the ischemic groups compared to controls (p = .002 for group 2 vs. group 6; p = .001 for group 2 vs. group 8). Histopathological evaluation of anastomotic line fibrosis was not found to show significant differences between the groups. Adequate tissue oxygenation is the main factor in wound and anastomosis healing. HBO treatment has a positive effect on biochemical and mechanical parameters of ischemic and normal colon anastomoses in rats. It is possible to see this effect more clearly with combined HBO treatment applied before and after ischemic anastomosis.

An adult choledochocele case presented with gastric outlet obstruction: a rare presentation.

Bile duct cyst is a biliary tract disease that is less common among adults compared to children, and it is accepted to have a congenital entity. The classical findings constitute a triad including abdominal pain, jaundice and abdominal mass. However, infective findings also occur in case of developed cholangitis, pancreatitis and cholecystitis. Duodenal obstruction leads to a rarely seen case in patients accompanied by nausea and vomiting, and it may easily be confused with other obstruction causes. We present a case report of an adult male patient with complaints of abdominal pain, and intermittent nausea and vomiting. Due to failure of attempted endoscopic approach for treatment, we performed transduodenal cyst excision during surgical procedure on the patient diagnosed to have type III biliary tract cyst. The complaints of the patient decreased significantly after the surgical therapy compared to the previous period and no complication was observed.

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 Urografin versus standard therapy in postoperative small bowel obstruction.

Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible.

Predictors of knowledge level and awareness towards breast cancer among Turkish females.

BACKGROUND: Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences among developed and developing countries, BC remains the most common cancer type of women in Turkey. OBJECTIVE: This study aimed to identify the level of knowledge, awareness, and their potential predictors towards BC in Ankara, Turkey. MATERIALS AND METHODS: The present descriptive study was conducted on 376 females attending a breast health outpatient clinic. A self-administered questionnaire was designed to evaluate knowledge level about BC and predictors effecting its level. Data analysis was performed using the chi-square test. A value of p<0.05 was considered statistically significant. RESULTS: Mean age of the participants was 46.2±9.93 (22-75). The majority (92.6 %) were married; 41.5% were educated less than nine years. Most of the women were housewives (82.7%) and, were living in an urban region (86.4%). Predictors of effecting responses to seven knowledge and awareness questions about BC varied from demographic features including older age groups, higher educational levels, being married, living in an urban area, being employee, smoking, having greater BMI to additional attributes associated breast health such as the increased number of births, applying for the purpose of control, positive family history of breast diseases, any diagnoses of breast diseases and performing BSE practice. CONCLUSIONS: It was determined that females in Turkey have better knowledge of BC than other developing countries even though it is not at the desired level. These findings revealed that females should be more informed about BC risk factors, prognosis and treatments by primary health-care providers to counteract the ascending burden of this disease.