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Objective: The aim of this study was to determine the DNA and genotypes of Echinococcus granulosus in liver cyst hydatids isolated in humans. Material and Methods: This study was conducted prospectively at the Department of General Surgery of the Cerrahpaşa School of Medicine, University of İstanbul-Cerrahpaşa, between January 2015 and June 2016 in 30 patients who were operated on for cystic Echinococcosis. E. granulosus DNA was analyzed using the Polymerase Chain Reaction (PCR) method in the cyst samples (protoscolex and/or germinative membrane) obtained during the operation, and genotype was determined in the PCR positive samples by sequence analysis. At the same time, indirect hemagglutination (IHA) was used to test for the presence of antibodies in the patients’ blood. Results: E. granulosus DNA was found in 29 out of 30 cystic Echinococcosis of the liver samples. All of the 29 cystic Echinococcosis samples were found to be G1 (sheep) species. Also, IHA was positive in 22 patients and negative in eight patients. Conclusion: In the present study, G1 species was the most commonly seen liver cystic Echinococcosis species. We suggest that a vaccine, which could be developed against prevalent regional genotypes, would be efficacious in the prevention of the disease with a cause of mortality and morbidity.

Background and aim: Vascular variations of grafts are handled with various reconstruction techniques in renal transplantation. We aimed to analyze the effects of these reconstruction techniques and sites on patient/graft outcomes. Materials and methods: Renal transplantation cases at the Transplantation Unit of the General Surgery Department, Istanbul University Cerrahpasa Medical Faculty between January 1st, 2000 and December 31st, 2012 were analyzed retrospectively. Postoperative duplex ultrasound results, urea-creatinine reduction rates, and complications were evaluated. Results: There were 228 living-donor transplantation cases evaluated. For single-renal-artery living-donor transplantations, there were 45 end-to-side external iliac artery, 15 end-to-side internal iliac artery, 152 end-to-end internal iliac artery, and 3 end-to-side common iliac artery anastomoses performed. In cases with double-arteries, 3 had end-to-side external iliac artery anastomoses, and 10 had end to-end internal iliac artery anastomoses. No statistically significant differences were found between reconstruction techniques with regard to complications or urea-creatinine reduction rates. Conclusion: Internal, external, and common iliac arteries can be safely used for anastomoses. The presence of more than one renal artery creates no short or long-term problems when a side-to-side anastomosis is initially performed. WOS:000668257500005 Q4

Background: The patient’s position is important for ensuring patient comfort and preventing complications after thyroidectomy. Objectives: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. Methods: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidec- tomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO2) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1st, 2nd, 3rd and 4th hours following thy- roidectomy. Results: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30° HOBE group at the 1st hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88-17.76; p0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p

In the present study, we aim to share our clinical experience in patients with spontaneous splenic rupture. Splenic rupture without trauma is known as spontaneous splenic rupture. The major problems in the management of spontaneous splenic rupture are missed or delayed diagnosis due to the lack of trauma in most cases. The records of all patients, who were admitted to Cerrahpaşa Medical Faculty, Istanbul University, were retrospectively reviewed from January 2000 to March 2013. Twelve patients were admitted to the emergency department and they were diagnosed with spontaneous splenic rupture. The mean age was 47.6 years. All patients had complaints of abdominal pain. The mean hematocrit value was 22%. Radiologic assessment revealed hemoperitoneum and/or subcapsular hematoma in 8 patients while splenic abscess was diagnosed in 2 patients. Eleven patients underwent splenectomy whereas one was managed conservatively. The most common cause of spontaneous splenic rupture was determined to be use of anticoagulants. Etiology was considered to be idiopathic in 1 patient. Two patients died in the postoperative period. Although rare, spontaneous splenic rupture must be suspected in emergency patients who have used especially anticoagulants and antiaggregants and who have had no recent history of trauma. One of the important causes of mortality is missed or delayed diagnosis.

Incisional hernia is a frequent complication of abdominal surgery developing in 11–20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group (P

Background: Laparoscopic surgery has proven to be safe and effective. However, the value of laparoscopic resection for malignancy in terms of cancer outcome can only be assessed by large prospective randomized clinical trials with sufficient follow-up. Methods: COLOR (COlon carcinoma Laparoscopic or Open Resection) is a European multicenter randomized trial which has started in September 1997. In 24 hospitals in Sweden, The Netherlands, Germany, France, Italy and Spain, 1,200 patients will be included. The primary end point of the study is cancer-free survival after 3 years. Results: Within Conclusions: Although laparoscopic surgery appears of value in colorectal malignancy, results of randomized trials have to be awaited to determine the definitive place of laparoscopy in colorectal cancer. Considering the current accrual rate, the COLOR study will be completed in 2002.

Die Echinokokkose, eine parasitare Krankheit, die am haufigsten in der Leber lokalisiert ist, wird in manchen Landern als eine endemische Krankheit betrachtet. Trotz eines gutartigen Verlaufs gehort sie wegen hoher Komplikationsrate und langer Aufenthaltsdauer im Krankenhaus zu problematosen Gebieten der Chirurgie. Wegen leichter Anwendbarkeit und niedriger Komplikations- und Rezidivrate ist die Cystenentleerung und Netzplastik die Therapie der Wahl.

Previous studies demonstrated the occurrence of bacterial translocation in biliary obstruction (BO). In this study, we investigated the effect of lactulose on the prevention of bacterial translocation in rats with BO. The study was performed in 4 groups of rats consisting of 15 animals each: (1) sham-operated controls, (2) sham-operated lactulose-treated, (3) BO physiologic-saline-treated and (4) BO lactulose-treated rats. Lactulose was given perorally by orogastric intubation in a dose of 2 ml of 33.5% solution/day. Fourteen days after BO, bacterial translocation to the mesenteric lymph nodes (MLN), liver, spleen and portal venous blood (PVB) was investigated. In sham-operated controls, 1 bacterial translocation to the PVB was observed. In the BO physiologic-saline-treated group, the rate of bacterial translocation to the MLN (p

Background/aims: Reactive oxygen species have a known potent role in the pathogenesis of ulcerative colitis. Iloprost, a pharma- ceutical, is a chemically stable derivative of a naturally- occurring human prostacyclin. Several studies have demonstrated protec- tive effects of iloprost via its antioxidant and its anti-inflammatory activity. The aim of this study is to evaluate the effects of ilop- rost on oxidant/antioxidant status, as well as the large bowel histopathology in experimental colitis. Materials and Method: Forty adult male Wistar-albino rats were randomly divided in to four equal weight-matched groups: sham group (n=10), iloprost admi- nistered sham group (n=10), colitis group (n=10), iloprost administered colitis group (n=10). Acetic acid (1 ml of 4% solution) was used to induce colonic inflammation in the rats. Results: Colonic tissue and plasma malondialdehyde levels were significantly lo- wer in the iloprost administered colitis group than the colitis group (p

Extrapelvic endometriosis is a rarely seen condition and it is occasionally presented to the general surgeons. It is often diagnosed incidentally.In this report we presented three cases of inguinal endometriosis all of which were thought to be inguinal hernia preoperatively. They were diagnosed during the operation for inguinal hernia repair and treated with simple excision of the lesions with a part of the round ligament.

Background/Aim: The aim of this study is to evaluate the diagnostic and therapeutic difficulties of gastric duplication cysts. Methods: A 38-year-old female patient presented with dyspepsia and repeated episodes of epigastric pain. She was operated with the diagnosis of pancreatic pseudocyst according to her US and CT scans, and found to have a gastric duplication cyst. A cyst about 80×80 mm, localized on the posterior wall of the corpus of the stomach close to the fundus, was dissected from the surrounding tissues and partially from the gastric wall. The cyst did not have muscle layer on the common wall with the stomach, so the cystic mucosa was stripped away from the gastric muscle layer. The gastric lumen was not entered. Results: Although gastric duplication cysts do not have specific symptoms and signs, CT, MR and endoscopic ultrasonography may help the preoperative diagnosis, but the diagnosis is usually confirmed at laparotomy. Needle aspiration may cause complications. Conclusion: Because of the complications that may occur after needle aspiration and malignant potential of the tissue, the treatment of these cysts is surgical.

Amaç: Son yıllarda Genel Cerrahi Uzmanlık Eğitimi'ne ilginin azaldığı veya ilk sıralarda tercih edilmediği şeklinde ortaya çıkan bir görüşün gerçek boyutunu saptamak amacıyla bir çalışma planladık. Yöntem: Ankara, İstanbul, İzmir ve Bursa'daki 9 Devlet Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalları'nda uzmanlık eğitimi yapan 202 asistana bir anket uyguladık. Bu anketimizde halen eğitim gören asistanların hangi Tıp Fakültesi'nden mezun oldukları, Tıpta Uzmanlık Sınavına kaç kez girdikleri, hangi sınavda başarılı oldukları, Genel Cerrahi uzmanlık alanını hangi sırada tercih ettikleri ve kazandıkları soruldu. Bulgular: Genel Cerrahi uzmanlık alanını 1. sırada, 202 asistanın ancak 40'ı (%19,8) tercih etmiştir. İlk girdikleri Tıpta Uzmanlık Sınavı'nda başarılı olanlar arasında Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nı tercih edenlerin %44,4 ile 1. sırada yer aldığı izlenmiştir. Genel cerrahiyi ilk sırada tercih edenlerin analizi yapıldığında %37,5 ile Hacettepe Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı ilk sırada yer almaktadır. Genel cerrahiyi ilk 3 sırada tercih edenlerin sonuçları incelendiğinde Uludağ Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı %64,3 ile 1. sırada yer almaktadır. ÖSYM-Tıpta Uzmanlık Sınavı 2009 Nisan Dönemi tüm uzmanlık alanlarının tavan puan sıralamasında 25 uzmanlık alanı içerisinde Genel Cerrahi 24. sırada yer almaktadır. Sonuç: Sonuç olarak uzmanlığa giriş sınavında tercih sırasında Genel Cerrahi'nin son sıralarda yer aldığı bu sonuçlarda da çarpıcı bir şekilde ortaya koyulmaktadır, Aim: We planned a trial to establish the realities on the suggestion which included the idea that there is loss of interest to General Surgery residency or it is not among the top choices. Material and Method: We performed a questionairre on 202 residents who studied general surgery residency in 9 state universities in Ankara, Istanbul, Izmir and Bursa. The residents were asked about which medical school they have graduated from, how many times they joined residency examination, in which examination they succeede to start residency and the order of their choice of general surgery residency was in their list. Results: Among those 202 residents, only 40 of them preferred general surgery residency as the first choice in their list (19.8 %). Most of residents who were successful in the first examination period preferred Ankara University General Surgery Department (44.4%). The residents who preferred general surgery residency as the first choice were found mostly in Hacettepe University General Surgery Department (37.5 %). Most residents who preferred general surgery residency in their first 3 choice in their list were found in Uludag University General Surgery Department (64.3 %). Examination for medical doctor residency April 2009 results have shown that general surgery residency was chosen in the 24th level among 25 branches. Conclusion: As a result general surgery residency was found to be placed at the end of the choices in residency examination among other branches in our trial.

Recurrence of hepatic hydatid disease is still a serious problem in endemic areas like our country. In this study, we present the causes and management of recurrences after surgical therapy of the hepatic hydatid cysts. Hepatic hydatid cyst patients treated surgically and followed afterward at Istanbul University, Cerrahpasa Medical Faculty, Department of General Surgery between January 1998 and January 2003 were evaluated retrospectively. During this period, 172 primary patients with hepatic hydatid disease were attended to at our clinic. Morbidity and mortality rates for this series were 5.8% and 0.58%, respectively. Recurrence rate was 4.65% during the follow-up period of 60.5 months (range, 25-84 months). Primary causes of recurrence were thought to be unnoticed cysts with exophytic development due to inadequate incision and exposition and spreading of the disease during conservative operative interventions. It is concluded that selection of the proper incision allowing complete exposition, and performance of pericystectomy in solitary, peripherally located cysts prevent recurrence.

Hepatic hydatid disease is still a commonly seen problem in endemic areas as well as in our country. There is a wide spectrum of therapeutic modalities ranging from simple medical treatment to radical liver resection. Progress in laparoscopic procedures made it possible to consider laparoscopic approaches in selected patients with hepatic hydatid disease. The current laparoscopic approach seems to be limited to cystotomy and drainage. There are fewer reports on hepatic resections or pericystectomy in the literature. In this article we present a case of laparoscopic pericystectomy performed in a selected patient.

Background: A hydatid cyst is still a serious health problem in endemic areas. Invasion of the spleen is rare in hydatid disease. In the medical literature, reports about isolated splenic hydatidoses are quite rare. Also there is not a consensus about the way of treatment. Methods: Between 1978 and 2000, in our clinic approximately 900 patients were operated on for an abdominal hydatidosis; 850 of these patients were treated for a hepatic hydatidosis and 14 patients for an isolated splenic hydatidosis. Six (42.8%) of the latter patients were male and 8 (57.1%) were female. The mean age of the patients was 47.14 ± 4.9 (range 17–72) years. Ten patients (71.4%) presented with a painful mass in the left upper quadrant of the abdomen, and the other 4 patients (28.5%) were asymptomatic and were diagnosed incidentally. Results: All of the patients underwent elective splenectomy. There was no mortality, but complications occurred in 4 (28.5%) patients. The period of hospitalization ranged from 7 to 17 days with a mean of 9.8 days. 1 patient died from an acute myocardial infarction during the 2nd postoperative year, and 1 patient died as a consequence of a traffic accident during the 5th postoperative year. Nine patients, after follow-up periods of between 2 and 14 years, are living free from disease. No recurrence occurred in any of them. In the remaining 3 patients, long-term follow-up could not be maintained. Conclusions: A hydatid cyst must be included in the differential diagnosis of cystic lesions of the spleen. A splenic hydatid cyst should be treated surgically due to the high risk of a rupture, and the ideal procedure in adulthood is standard splenectomy.