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Byline: Fehmi Celebi (1), Ahmet A. Balik (1), Bedii A. Salman (2), Durkaya Oren (1) Keywords: Hydatid disease Surgical management Abstract: To review the results of different modalities of treatment of hydatid disease of the liver (HDL) in pediatric patients, 31 children treated surgically between 1990 and 2000 at the departments of general surgery and pediatric surgery, Ataturk University School of Medicine, were reviewed retrospectively 19 were male and 12 were female. The mean age was 8.4 years (range 4--12 years). The most common complaints were an abdominal mass and right-upper-quadrant pain, which were present in 35.5% and 77.4% of cases, respectively. Twenty-five cysts were in the right lobe, 2 in the left lobe, and 4 in both lobes 8 patients had multiple hepatic cysts and 5 had coexisting cysts in other organs. Surgical procedures were: unroofing plus tube drainage (UTD) capitonnage omentoplasty and pericystectomy. Of the patients treated by UTD, 2 developed cholangitis and 1 developed a biliary fistula. Of the patients with capitonnage, 1 developed cholangitis. Surgery is still one of treatment modalities for management of HDL. Omentoplasty and capitonnage are the most effective modalities for the management of the cyst cavity. Author Affiliation: (1) Department of General Surgery, Ataturk University School of Medicine, Erzurum, Turkey (2) Department of Pediatric Surgery, Ataturk University School of Medicine, Erzurum, Turkey Article History: Accepted Date: 19/02/2002 Article note: Electronic Publication

Objective: To compare postoperative morbidity and mortality results in patients with and without endoscopic and percutaneous transhepatic biliary drainage due to obstructive jaundice caused by a periampullary tumor and to examine the effect of intervals until surgery on postoperative morbidity and mortality in patients who underwent preoperative biliary drainage (BD)., Methods: Patients were divided into 3 groups according to their BD status. Group1, no biliary drainage (NBD), Group2, Endoscopic biliary drainage (EBD), Group3, Percutaneous transhepatic biliary drainage (PBD). Patients who underwent biliary drainage before pancreaticoduodenectomy (PD) were divided into 3 intervals according to the time interval between drainage and surgery: Short interval; patients undergoing surgery in 21 days and <, Medium interval; between 22-42 days, Long interval; 43 days and >. Groups and intervals were compared in terms of postoperative morbidity and mortality., Results: Of the 122 patients who underwent PD, 76 (62.3%) were male, and 46 (37.7%) were female. Within these patients, 47 (38.52%) had NPD, 42 (34.42%) had EBD, and 33 (27.05%) had PBD. The rate of postoperative Grade B and C fistula was higher in the groups that underwent preoperative drainage compared to the group without preoperative drainage (p = 0.007)., Conclusion: It was determined that the postoperative complication rate was lower in patients who did not undergo BD compared to patients who underwent biliary drainage. Besides, the endoscopic drainage method was observed to be associated with fewer complications than the percutaneous transhepatic drainage method., Key Words: Preoperative biliary drainage, Pancreaticoduodenectomy, Periampullary tumors, Post procedure complication, Timing.

Background: In colorectal cancer (CRC), the mutation of the K(N)RAS gene has a significant impact on the clinical course, and is associated with a negative prognosis. We aim to present the morbidity and long-term results in patients with wild/mut-K(N)RAS, undergoing CRC surgery., Methods: A total of 116 patients who underwent surgery for colorectal cancers with wild/mut-K(N)RAS were included in this retrospective study. The patients were divided into two groups: wild-K(N)RAS patients (Group 1) and mutant- K(N)RAS patients (Group 2). Results were evaluated for clinical, operative, morbidity and long-term survival outcomes., Materials and Methods: The highest surgical site infection (SSI) rate (OR=140.339)(4.303-4581.307)(P=0.005) was seen in patients given Bevacizumab during neoadjuvant treatment. Meanwhile, the SSI site infection rate was at its lowest in cases where minimally invasive surgery was preferred (OR=0.062)(0.006-0.628)(P=0.019). In addition, the overall median survival rate for the total cohort was 38±3.1 (31-44) months. Multivariate analysis showed that CEA (>5ng/mL)(HR 2.94)(1.337-6.492))(P=0.007); tumor stage (P=0.034), T(T4) stage (HR 1.91)(1.605-252.6)(P=0.02); metastasectomy/ablation (HR 0.19)(0.077-0.520)(P=0.001); the number of removed metastatic lymph nodes (HR 1.08)(1.010-1.155)(P=0.025); tumor implant or nodule (HR 2.71)(1.102-6.706)(P=0.03); curative resection (HR 2.40)(0.878-6.580)(P=0.042) to be factors affecting the overall survival rate., Conclusion: Treatment with Bevacizumab during the neoadjuvant period in mut-K(N)RAS cases, surgical technique and complications of Grade 3 or higher are risk factors for SSI on morbidity in patients with mut/wild-K(N)RAS undergoing colorectal cancer surgery. Moreover, CEA (>5ng/mL), tumor stage, T stage, metastasectomy/ablation, the number of removed metastatic lymph nodes, tumor implant/nodule and curative resection are risk factors on the overall survival rate., Key Words: Bevacizumab, Colorectal cancer, K(N)RAS mutation, Morbidity, Mortality.

Background: Pilonidal sinus disease is a common disease of young adults, which most frequently occurs in the sacrococcygeal region on the skin's midline. Various procedures, ranging from simple incision and curettage to complex flaps for natal cleft obliteration, have been described in the literature., Material/methods: We aimed to present the dermographic characters, post-operative complications, length of stay in hospital, time of return to daily activities, and recurrence rates of the patients in which we applied sinus excision and fasciocutaneous V-Y advancement flap due to primary complicated or recurrent sacrococcygeal pilonidal sinus disease., Results: Patients with primary complicated and recurrent pilonidal sinus received a fasciocutaneous V-Y advancement flap in the general surgery service of our hospital. Eleven patients had recurrent disease. Thirty-seven patients received a unilateral V-Y flap and 8 patients received a bilateral V-Y flap. None of the patients had post-operative flap necrosis or wound opening. Two of the patients had a self-draining simple seroma and 3 of the patients had delayed wound healing in the perianal region of the incision, which was treated with dressing. The mean time required to return to daily activities was 7 days, and return to work took 17 days. In the mean 25-month follow-ups of the patients, no recurrences were detected., Conclusions: We think that fasciocutaneous V-Y advancement flap is an easily learned and practicable method that reduces the recurrences in the patients with primary complicated and recurrent pilonidal sinus, length of stay in hospital, and time to return to daily activities and work in the post-operative period.

Purpose: This study aimed to investigate the autoimmune basis of idiopathic granulomatous mastitis (IGM) by determining the anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) levels of patients diagnosed with IGM., Material and Methods: Twenty-six IGM patients were evaluated. Serum samples were analyzed for autoantibodies by indirect immunofluorescence (IIF) using a substrate kit that induced fluorescein-conjugated goat antibodies to human immunoglobulin G (IgG). IIF patterns were read at serum dilutions of 1 : 40 and 1 : 100 for ANA positivity. Using the immunoblot technique, the sera of patients were assayed at dilutions of 1 : 40 and 1 : 100 for human autoantibodies of the IgG class to 15 lines of highly purified ENAs., Results: In the IIF studies for ANA, positivity was identified for four different patterns in the 1 : 40 diluted preparations, for three different patients in the 1 : 100 diluted preparations and only one pattern was identified at the 1 : 320 dilution. In the ENA studies, positivity was identified for four different pattern in the 1 : 40 dilution, and only one pattern was identified at the 1 : 100 dilution., Conclusion: This study was not able to support the eventual existence of an autoimmune basis for IGM.

Strongyloidiasis is a parasitosis caused by the female nematode of the Strongyloides stercoralis. S. stercoralis causes a chronic infection that is asymptomatic in 50% of chronically infected patients, and it can also affect the stomach. Gastric involvement causes symptoms mostly mimicking gastritis. We report herein a case of gastric perforation in a 37-year-old woman, which was thought to be caused by S. stercoralis.

We aimed to investigate the ameliorating effect of dehydroepiandrosterone (DHEA) on the potential hepatocellular damage in experimental obstructive jaundice. Twenty-four male rabbits in the study were randomly allocated into three groups. In the sham group, the choledochal canal was identified and explored. In the obstructive jaundice and treatment groups, the choledochal canal was ligated. Placebo and DHEA were administered to the obstructive jaundice and treatment groups, respectively. Blood samples were obtained at baseline, and both blood samples and liver tissue samples were obtained by re-laparotomy performed on day 8. Biochemical parameters were measured in blood samples, and liver samples were histopathologically evaluated. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP) and bilirubin levels were lower in the treatment group than in obstructive jaundice. Mononuclear inflammation in the portal region and hepatocyte degeneration were milder in the treatment group compared to obstructive jaundice group. Fibrosis and necrosis were also recovered by the DHEA treatment.In conclusion, these findings suggested that DHEA may reduce the obstructive jaundice-induced hepatocellular damage.

Background: Blunt colonic injuries are rare but can complicate the management of the blunt trauma patient and worsen the outcome. We analyzed in this study the colonic injuries caused by blunt abdominal trauma., Methods: The records of 64 patients (60 male, 4 female; mean age 39.3 years; range 16 to 69 years) were investigated retrospectively. The records were reviewed for clinical presentation, investigations, diagnostic methods, associated injuries, time from injury to operation, site of colon injury, operative management, morbidity, and mortality., Results: One-stage operation was performed in 53 cases (82.8%) and two-stage operation in 11 cases (17.2%). The treatment chosen was strongly related with the degree of fecal contamination and grade of colonic injury (p<0.01). The overall incidence of colonic injury-related abdominal complications was 26.5% (17 cases). There were six non-colon-related and one colon-related mortalities. Shock at presentation, severe fecal contamination, colon injury scale (CIS) grade, and associated injuries were related with complications and mortality., Conclusion: We conclude that in patients with shock at presentation, severe fecal contamination and higher CIS grade, two-staged operation is appropriate.

Objective: To investigate the effects of combined use of glutamine and growth hormone on bacterial translocation., Methods: The study was performed at the laboratories of the Department of Physiology at Ataturk University Medical School, Erzurum, Turkey between June and September 2007. Forty rats divided into 5 groups of 8, were included in the study. In the study groups, the common bile duct was ligated to obtain obstructive jaundice. The rats in the control group CG were given sodium chloride, in the glutamine group GLG they were given glutamine, in the growth hormone group GHG, growth hormone, and in the glutamine + growth hormone group GLGHG glutamine + growth hormone at equal doses by the same methods. Blood, spleen, liver, lymph node, and cecal content samples were obtained. Total bilirubin TB, alkaline phosphates ALP, and gamma glutamine transferase GGT activities were evaluated., Results: In the CG, cecal contents were higher than in the GLG, and cecal contents and BT were higher than in the GHG and the GLGHG. The BT rate was the lowest in the GLGHG, with a borderline difference with the values of the GLG and GHG., Conclusion: We found that in preventing BT, combined use of glutamine, and growth hormone was more effective than using each of these agents alone.

The adult form of the small cestode Echinococcus multilocularis is found in carnivorous animals, especially in the fox. This cestode, which is found in the northern hemisphere in the world, is the cause of a generally fatal disease in humans, known as alveolar echinococcosis (AE). The metacestodes of Echinococcus multilocularis can be experimentally developed in the Meriones unguiculatus species of rodents, and it is possible to use these metacestodes for numerous purposes, primarily for supplying the antigens required for serological diagnosis of the disease. It is with this aim that in this study for the first time in Turkey, Echinococcus multilocularis metacestodes were developed using different kind of rodent, Rattus norvegicus, and an indigenous strain was isolated using the surgical material of a patient diagnosed with alveolar echinococcosis.

Purpose: This study was designed to review the outcomes of 63 patients with ileosigmoidal knotting., Methods: Sixty-three, surgically treated patients (47 males; 74.6 percent) were reviewed retrospectively. The mean age was 45.6 (range, 7-75) years. The most common symptoms were abdominal pain and obstipation, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was obstructive emergencies in 49 patients (77.8 percent) and nonobstructive emergencies in 14 (22.2 percent)., Results: All patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was Type 1A in 30 patients (47.6 percent), in which the active ileum encircled the passive sigmoid colon in a clockwise direction. Fifty patients (79.4 percent) developed gangrenous bowel. Resection of gangrenous segments and enteroenteric or enterocolic anastomosis combined with the Hartmann procedure was the most preferred operation, used in 34 patients (54 percent). The mortality rate was 15.9 percent (10 patients), and toxic shock was the most frequent cause of death., Conclusions: Ileosigmoidal knotting is a rare but serious form of intestinal obstruction. Its preoperative diagnosis is difficult and may present as an obstructive or nonobstructive emergency. Early and effective resuscitation, prompt surgical intervention selected on the basis of clinical and operative findings, and effective postoperative intensive care are the basis of treatment.