Search

Background/Aims:The study aimed to determine the waiting times of the patients admitted to the general surgery clinic from an emergency department and to investigate the effectiveness of services.Methods:1564 patients over the age of 18 admitted to the General Surgery Clinic from the emergency department of Health University BursaTraining and Research Hospital between 01.01.2018 and 31.12.2018 were included. Age, gender, admission and waiting times, the diagnoses, and surgical history or hospitalization were retrospectively analyzed. The difference between the admission time to the emergency department and the admission time to the general surgery clinic was accepted as waiting time.Results:56% of the patients (n: 876) were male and the mean age was 49.9. The mean waiting time in the emergency department was 440.85 minutes and the mean hospital stay was 4.67 days. The minimum waiting time was in abdominal trauma (249.49 min) whereas the longest waiting time was in mesenteric ischemia (732.27 min) in the emergency department.Conclusions: We believe that having a separate and senior team in emergency services of work-intensive departments such as general surgery will contribute to shortening waiting times and providing faster and more effective health care.

Objectives The majority of bile duct stones (BDS) that cause acute biliary pancreatitis (ABP) pass spontaneously into the duodenum. If not passed, they worsen the prognosis or cause recurrence. Therefore, they must be treated. The purpose of this study was to assess the number and timing of spontaneous passage of BDS using magnetic resonance cholangiopancreatography (MRCP) and to determine the effect of this approach on endoscopic retrograde cholangiopancreatography (ERCP). Methods Sixty patients diagnosed with ABP were evaluated prospectively. MRCP was performed between the 1st and 4th days of an acute attack in all the patients. A control MRCP was performed after 7 days in patients with MRCP-identified choledocholithiasis. Patients in whom BDS were visible on imaging or who showed no decrease in bilirubin or cholestasis enzymes underwent ERCP. Results MRCP revealed choledocholithiasis in 20 (33%) of the 60 patients. In the control MRCP imaging, choledocholithiasis was detected in 16 of 20 (80% of those who had stone initially) patients. ERCP was performed in these patients and in 2 patients who did not have BDS on the control MRCP but whose bilirubin values and cholestatic enzyme levels had not decreased. ERCP verified choledocholithiasis in 16 of the 18 patients. The positive predictive value of MRCP was 93.7% (15/16). Conclusions MRCP performed in the second week in ABP patients with a nonworsening prognosis and a suspicion of choledocholithiasis will give more specific results. This will avoid unnecessary ERCP and the potential morbidity and mortality that can develop with this invasive procedure.

Enemas are widely used in patients with poor colon cleansing in preparation for colonoscopy. Although they are regarded as having minimal side-effects, enemas can give rise to severe side-effects due to the chemical substances they sometimes contain. We report a case of ischemic colitis emerging in association with enema use during preparation for colonoscopy in a 45-year-old woman who was performed rectal resection due to ischemia-related stricture

This study was performed to compare the use of a bilateral gluteus maximus advancing flap (BGMAF) following oblique incision, which was recently described for the surgical treatment of sacrococcygeal pilonidal sinus (SPS) disease, with the widely used Limberg flap (LF) technique following a rhomboid incision.A total of 105 patients treated for SPS were evaluated retrospectively. The patients were evaluated in terms of their age, body mass index, symptoms, length of the operation, complications, postoperative hospital stay, time to return to work, postoperative cosmetic satisfaction and recurrence rate.Fifty-six of the patients were treated with BGMAF, while 49 were treated with LF. The mean follow-up was 20.5 ± 5.4 months. The mean length of the operation, hospital stay and time to return to work were shorter, while the cosmetic satisfaction score was higher in the BGMAF group compared to the LF group. There was no statistically significant difference between the groups for the other criteria.The BGMAF appears to be superior to the LF in terms of the length of the operation, time to return to work and degree of cosmetic satisfaction. It is preferable for sinuses not to require wide excision, while the LF is more appropriate for sinuses with a large post-excision defect.

Yıldar, Murat (Balikesir Author), Objective: Enema administration in the morning of routine colonoscopy is known to be useless. However, the potential bowel cleansing effects of distal colon emptying with enema prior to purgatives are not known. The aim of this study is to investigate the effects of enema use before purgatives in preparation for colonoscopy. Material and Methods: Two hundred twenty-seven patients were randomly assigned into three groups; enema before purgative use, enema after purgative use, and no enema. Patients were compared in terms of age, sex, BMI, Rome III constipation criteria, history of abdominal surgery, tolerance to the preparation procedure, complications during preparation such as nausea, vomiting, headache and dizziness, cecal insertion time, total duration of colonoscopy, polyp determination rate and colonic cleansing based on the Boston Bowel Preparation Scale. Results: One hundred two (44.9%) patients were male and 125 (55.1%) female. The mean age and BMI was 55.4 +/- 11.8 years and 28.8 +/- 4.7, respectively. No difference was observed between the groups in terms of sex, age, or BMI. The number of fulfilled Rome criteria and of previous abdominal surgeries were significantly higher in females than in men. Right colon Boston Bowel Preparation Scale score was higher in the group using enemas before purgatives than the scores of other groups. This improvement was statistically significant in the female patient group with higher constipation rate. Conclusions: Use of enemas before purgatives in patients with constipation significantly improves adequacy of right colon cleansing.

research, AMAÇ: Protokateşuik asit (PCA) yeşil çay, fındık, badem başta olmak üzere birçok bitki, sebze ve meyvede yaygın olarak bulunan anti-oksidan özelliği olan basit bir fenol bileşiğidir. Bu çalışmada PCA'nın iskemi/reperfüzyon (IR) hasarı oluşturulan böbrekler üzerine olan etkilerini araştırmayı amaçladık. GEREÇ VE YÖNTEM: Sprague-Dawley cinsi sıçanlar rastgele dört gruba ayrıldı: (1) Sham, (2) Renal IR (3) Renal IR + Vehicle (4) Renal IR + PCA. Renal IR hasarı sağ nefrektomi yapıldıktan sonra 45 dakika boyunca sol renal pedikül klemplenip sonrasında üç saat boyunca reperfüzyon yapılarak indüklendi. Tedavi edici olarak kullanılan PCA renal iskemiden hemen önce 80 mg/kg dozunda intraperitoneal olarak uygulandı. Protokateşuik asiti çözmek için araç olarak %33'lük polietilen glikol kullanıldı. Sıçanlar sakrifiye edildikten sonra alınan kan örmeklerinde ve böbrek dokusunda total antioksidan kapasite (TAS), malondialdehit (MDA), süperoksitdismutaz (SOD), tümör nekroz faktör alfa (TNF-?), interlökin-6 (IL-6) seviyesi ölçüldü. Böbrek doku örneklerinde histopatolojik incelemeler yapılarak histopatolojik skorlama elde edildi. Apoptotik hücreleri görüntülemek için terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick-end-labeling (TUNEL) boyama yapıldı. BULGULAR: Protokateşuik asitin serum MDA ve TNF-? ile böbrek MDA seviyelerini anlamlı olarak azalttığı, serum ve böbrek TAS ile SOD seviyelerini ise anlamlı olarak artırdığı görüldü. Histopatolojik skorlamanın PCA verilen grupta anlamlı olarak daha iyi idi. TARTIŞMA: Oksidatif stresi ve renal iskemi reperfüzyon hasarını azalttığını ortaya koyduğumuz PCA, IR hasarına karşı etkili bir ajan olarak kullanılabilir. Anahtar sözcükler: Antioksidanlar; iskemi reperfüzyon hasarı; malondialdehit; protokateşuik asit; serbest oksijen radikalleri., BACKGROUND: Protocatechuic acid (PCA), which has antioxidant property, is a simple phenolic compound commonly found in many plants, vegetables, and fruits, notably in green tea and almonds. Present study was an investigation of the effects of PCA on rat kidney with ischemia/reperfusion (IR) injury.METHODS: Sprague-Dawley rats were randomly divided into 4 groups: (1) Sham, (2) Renal IR, (3) Renal IR+Vehicle, and (4) Renal IR+PCA. Renal reperfusion injury was induced by clamping renal pedicle for 45 minutes after right nephrectomy was performed, followed by reperfusion for 3 hours. Dose of 80 mg/kg PCA was intraperitoneally administered to 1 group immediately before renal ischemia; 33% polyethylene glycol was used as vehicle. Total antioxidant status (TAS), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor alpha (TNF-?), and interleukin-6 levels were measured in blood and kidney tissue samples taken from sacrificed rats. Kidney tissue samples were examined and scored histopathologically. Terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick end labeling assay method was used to detect apoptotic cells.RESULTS: It was found that PCA significantly reduced serum MDA, TNF-?, and kidney MDA levels, while it increased serum and kidney TAS and SOD levels. Histopathological scores were significantly higher for the group given PCA.CONCLUSION: PCA reduced oxidative stress and can be used as an effective agent in treatment of renal IR injury.

Background Acute mesenteric ischemia is a life-threatening clinical entity. 2-Aminoethoxydiphenyl borate (2-APB) is a membrane-permeable modulator of intracellular inositol triphosphate-induced calcium release. We investigated the effects of different 2-APB doses on intestinal ischemia-reperfusion injury in an experimental rat model. Methods We divided 24 Wistar albino rats into four groups: sham, control, ischemia-reperfusion +2 mg/kg 2-APB, and ischemia-reperfusion +4 mg/kg 2-APB. The sham group only underwent laparotomy for 1 h 30 min. A 30-min period of mesenteric ischemia was induced in the control and two treatment groups, followed by 1 h of reperfusion. Before the laparotomy, 2 mg/kg and 4 mg/kg 2-APB was administered i.v. in the treatments groups, and blood samples were collected after reperfusion. Serum levels of malondialdehyde, superoxide dismutase, glutathione, total antioxidant capacity, tumor necrosis factor (TNF)-alpha, and interleukin-6 were analyzed. Intestinal tissues were taken for histopathological, DNA fragmentation, and terminal deoxynucleotidyl transferase dUTP nick end labeling analyses to determine the proportion of apoptotic cells. Results 2-APB reduced serum malondialdehyde, TNF-alpha, and interleukin-6 levels. However, superoxide dismutase and total antioxidant capacity levels increased significantly in the 4-mg/kg 2-APB group (p < 0.05). The intestinal histopathological injury scores were significantly higher in the control group; these injuries were prevented in the 4-mg/kg 2-APB dose group. DNA damage after ischemia-perfusion decreased significantly in the 4-mg/kg 2-APB group compared with the control group. Conclusion 2-APB decreases oxidative stress and cell injury. Administering 4 mg/kg 2-APB prevented ischemia-perfusion injury by diminishing histological damage.

Intraduction: The aim of the study is to investigate the protective effect of 2-aminoethyl diphenylborinate on an acute pancreatitis model through an experimental study. Materials and Methods: 30 Spraque-Dawley male rats were randomly divided into three groups: Sham , Pancreatitis and Pancreatitis + 2-APB. Pancreatitis was induced by L-arginine administration. The therapeutic agent 2-APB was performed i.v. at a dose of 2 mg/kg 10 min before pancreatitis induction. From blood samples, superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity, tumor necrosis factor alpha, interleukin-6, aspartate aminotransferase , alanine aminotransferase and creatinine levels were measured and the rats were sacrificed subsequently. Tissue samples were evaluated histopathologically. TUNEL staining method was used to visualize apoptotic cells. Results: 2-APB significantly reduced serum MDA and creatinine levels in pancreatitis + 2-APB group. Unfortunately, SOD levels reduced significantly, too. Edema and hemorrhage in pancreatic tissue were lower, necrosis and fibrosis were higher in the 2-APB administered group. Additionally, in 2-APB given group, it was found that vacuolisation, epithelial desquamation, and congestion reduced in renal tubular epithelial. The number of apoptotic cells did not change in the pancreatic tissue in TUNEL staining. Conclusions: 2-APB reduces renal damage caused by acute pancreatitis. However, protective effect has not been on pancreatic tissue with 2-APB administered group. Although 2-APB, which was shown to prevent the degradation of kidney functions due to pancreatitis, do not minimize the pancreas tissue damage, it can improve the prognosis of pancreatitis by reducing the damage of distant organs

Purpose. In the study presented, preoperative examinations and surgical methods were discussed along with literature, regarding two cases who were operated with the prediagnosis of acute appendicitis and for whom caecum diverticulitis was determined.Case 1. 21 years old male patient who had applied to hospital with complaint of abdominal pain, underwent an operation with a prediagnosis of acute appendicitis. Right hemicolectomy was performed with mass perioperatively determined in caecum. Histopathological examination revealed necrosis and inflammation in diverticulum wall.Case 2. 36 years old female patient applied to emergency department with abdominal pain and underwent an operation with a prediagnosis of acute appendicitis. Appendectomy and diverticulectomy were performed for whom inflame diverticula in caecum was determined perioperatively. Histopathological examination was revealed acute inflammation in diverticulum wall.Conclusion. Although solitary caecum diverticulitis is a rarely encountered disease, it must be considered in the differential diagnosis of right lower abdomen pain.

Yıldar, Murat (Balikesir Author), Objective. In the present study, since PON1 is known as an HDL-associated antioxidant enzyme that inhibits the oxidative modification of LDL and oxidative stress plays a role in the pathogenesis of mesenteric ischemia, we investigated the changes in PON1 activity and lipid profile in an experimental ischemic colitis model. Methods. Forty male Wistar albino rats were divided into two groups: the control group (N = 15) and the experimental group (N = 25). All animals were anesthetized with ether and ketamine anesthesia to undergo a midline laparotomy. Ischemic colitis was induced by marginal vessel ligation in the splenic flexura (devascularization process). A sham laparotomy was performed in the control group. All animals were sacrificed on the seventh postoperative day. Oxidative stress marker (malonyldialdehyde, MDA), lipid profile, and paraoxonase (PON-1) and arylesterase activities were determined. Histopathological evaluation was done under light microscopy, after sectioning and staining with hematoxyline and eosin. Statistical analysis was conducted using Student's t-test and Mann-Whitney U test, and P < 0.05 was considered as statistically significant. Results. There was a significant decrease in both serum and tissue PON1 activity in ischemic colitis group (P < 0.01, for each). Similarly, arylesterase levels showed a parallel decrease in both tissue and serum of the experimental group (P < 0.01 and P < 0.001, retrospectively). MDA, an oxidative stress marker, was seen to increase in the experimental group (P < 0.01, tissue; P < 0.05, serum). In experimental group, there was a significant rise in serum total cholesterol and LDL levels (P < 0.001, for each). However, HDL level decreased significantly (P < 0.001). Triglycerides did not show any change between the groups (P > 0.05).Conclusions. PON1 and arylesterase play an important role in the pathophysiology of ischemic colitis