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Byline: Ayse. Merter, Burhan. Mayir, Okan. Erdogan, Taner. Colak Objectives: Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent [...]

Objective: To evaluate the effect of laparoscopic cholecystectomy performed under different intraabdominal pressure on oxidative stress markers. Material and Methods: This prospective, randomized, controlled study examined 90 consecutive healthy patients who underwent elective laparoscopic cholecystectomy with the diagnosis of symptomatic cholelithiasis. The patients were divided into three groups, 30 patients in each. Group 1 included patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 7 mmHg, Group 2 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 10 mmHg, and Group 3 patients who underwent laparoscopic cholecystectomy at a CO2 pneumoperitoneum pressure of 13 mmHg. Blood samples were collected preoperatively, perioperatively, and postoperatively for measurement of the serum levels of ischemia modified albumin and an analysis of total antioxidant status and total oxidant status. Intra-group comparisons were made. Results: Group 1 experienced a significant increase in the postoperative ischemia modified albumin values compared to preoperative ischemia modified albumin values (p=0.013). Group 2 experienced a significant decrease in the perioperative total antioxidant status values compared to preoperative and postoperative total antioxidant status values (p=0.009). Group 3 experienced a significant increase in the perioperative total oxidant status and oxidative stress index values compared to preoperative values (p<0.001). Group 3 experienced a significant increase in the perioperative and postoperative ischemia modified albumin values compared to preoperative values (p<0.001). Conclusion: Increased levels of oxidative stress markers were detected in patients who underwent laparoscopic cholecystectomy at a high intraabdominal pressure level. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative morbidity and mortality are more frequent among older patients due to reasons such as decreased organ function and accompanying disorders and malnutrition. Laparoscopic interventions in the elderly patients can also contribute to morbidity and mortality. The purpose of this study was to assess the safety of laparoscopic cholecystectomy in the aged and very aged patients. Materials and Method: The patients were divided into three groups based on age. Groups 1, 2 and 3 comprised patients aged <65, 65-79 and =80 years, respectively. Each group included 50 consecutive patients who had undergone laparoscopic cholecystectomy. Results: The groups were different from each other in terms of pre-operation albumin level, American Society of Anesthesiologist (ASA) score, existence of hypertension, coronary artery disease and chronic obstructive lung disease, duration of the operation, emergency operation ratio, morbidity rates. Morbidity was observed in 13 (8.7%) patients, with pulmonary complications in six, cardiac complications in five and infectious complications in two. There was no mortality in the study groups. The rate of morbidity was significantly higher in patients aged>80 years than other patients. Incidence of coronary artery disease, chronic obstructive pulmonary disease, low hemoglobin and albumin levels and high ASA score occurred more frequently in patients with morbidity. Logistic regression analysis showed that presence of chronic obstructive pulmonary disease and low albumin levels was associated with morbidity. Conclusion: In the very aged patients, for whom cholecystectomy has been planned, laparoscopic cholecystectomy can be performed safely. However, laparoscopic cholecystectomy should be performed only after thorough patient evaluation and presurgical preparation because the most important factors associated with morbidity and mortality are co-existing disorders and nutritional status. [ABSTRACT FROM AUTHOR]

Objective: Vascular sealing devices (VSD) can be safely used in thyroid surgery. The purpose of this survey was to investigate general surgeons'approach to the use of VSD in thyroid surgery in Turkey. Material and Methods: A questionnaire containing 10 items was prepared and announced via the Dialogue in Endocrinology Society website. The results were then analyzed. Results: Fifty surgeons (65.8%) stated that they always use VSD, 20 (26.3%) stated that they sometimes use these devices and six (7.9%) declared that they never use VSD. Thirty-six surgeons (47.4%) reported that they use ligation all the time, and 42 (55.3%) stated that upper pole vessels should be ligated at least once. Twenty two point four percent of the responders stated that they faced a complication, which they thought was related to VSD. Conclusion: The vast majority of surgeons routinely uses VSD and accepts it as a safe tool. However, the observed complication rate was very high. [ABSTRACT FROM AUTHOR]

Fibromatosis is the most common primary tumor of mesentery. Mesenteric fibromatosis is a very rare lesion which does not metastasise but can be locally aggressive. Fibromatosis may be classified as extra-abdominal, abdominal wall, or intra-abdominal. The etiology of fibromatosis has not been determined. Most of the patients with mesenteric fibromatosis are asymptomatic. Herein, we presented a case who was 45 years old, complained of left lower quadrant pain. Preoperative evaluation included abdominal ultrasound, computed tomography (CT). According to the CT report, the patient was diagnosed with gastrointestinal stromal tumor. A mobile mass was seen on the jejunal mesentery during laparoscopic exploration. The tumor was removed by wide excision with safe margins. Patients was discharged on the fifth day of the operation. The histological diagnosis was of jejunal agressive fibromatosis. Even though there are different types of treatment protocols, surgery with negative surgical margin is preferred to prevent local recurrence. In these type of cases safe margins can be achieved with wide laparoscopic excision. [ABSTRACT FROM AUTHOR]

Objective: Sentinel lymph node biopsy is the recommended approach in the evaluation of axilla during breast cancer surgery. In this study, results of patients who underwent methylene blue sentinel lymph node biopsy were evaluated. Materials and Methods: The study included 32 female patients with T1 and T2 tumors. 5 ml of 1% methylene blue was injected into the peritumoral area or around the cavity. The axillary sentinel lymph node was found and removed, and then axillary dissection was performed. The sentinel lymph node and axillary dissection specimen were histopathologically examined and the results were compared. Results: The sentinel lymph node was found in 30 (94%) patients. Lymph node metastasis was not observed in 17 patients in both the sentinel lymph node and axilla. Two patients had metastasis in the axilla although this was not detected in sentinel lymph node. Eleven patients had metastasis both in the sentinel lymph node and in the axilla . The accuracy rate was 93%, and the false negativity rate was identified as 15%. Conclusion: Sentinel lymph node biopsy by methylene blue is a method that can be applied with high accuracy. Methylene blue can be considered as an alternative to isosulphane blue in sentinel lymph node biopsy. [ABSTRACT FROM AUTHOR]

Introduction: Thyroidectomy is commonly performed procedure aming general surgery oeprations. There are controversy about surgical approach of thyroid operations. In tis research we compared results of total thyroidectomy versus subtotal thyroidectomy for multinodular goitre. Material and method: Records of patients that have undergone thyroidectomy with diagnosis of multinodular goitre are investigated retrospectively. Results of patients compared in two goups as total thyroidectomy and subtotal thyroidectomy. Results: 195 operations performed. 150 of patients have undergone total thyroidectomy. Hypocalcemia developed in 7 patients permanently, and 30 patients temporary. Temporary hypocalcemia was more common in total thyroidecmy group. One sided larengeal nevre injury occured permanently in one patient and temporarly in four patients. Discussion: Altough complication rates of total thyroidectomy similar or slightly higher than subtotal thyroidectomy, to prevent recurrence of disease or to provide sufficient treatment in patients with cancer, total thyroidectomy must be the procedure to be preferred. [ABSTRACT FROM AUTHOR]

Hyperparathyroidism is a well known disease group, with extensive surgical application. In the last two decades, preoperative imaging investigations and surgical approach to primary hyperparathyroidism have changed. While bilateral neck exploration was the former standard procedure, minimally invasive parathyroidectomy has become the present standard procedure for most surgeons. Quick parathormone assay is an effective method that aids the decision to terminate the surgery. However, there is no consensus about which criterion should be used while giving the decision of termination. In this report, we reviewed trials in which different quick parathormon assay criteria have been used. [ABSTRACT FROM AUTHOR]

Postoperative bleeding is a rare cause of mortality after thyroid surgery. Most of life threatening bleeding ocuur after 4 to 6 hours after surgery, rarely can be seen after 24 hours. In this article we present a case in whom we experienced life threatening bleeding late after thyroidectomy. During operation ultrasonic coagulation device was used for coagulation of vessels. Total thyroidectomy was performed a 54 year old female patient. She had a sudden swelling of throat, dyspnea and cyanosis after coughing. Hematoma was drained immediately at bed of patient by opening sutures. Afterwards she was taken to operation room, bleeding from right upper polar artery was recognised and tied. Patients must be followed after thyroidectomy for bleeding at least for 24 hours. In selected cases, suturation of big vessels can decrease bleeding ratio. [ABSTRACT FROM AUTHOR]

Introduction: Among surgical procedures, thyroidectomy is commonly performed surgery. Approximately 10-15 %of patients require re-thyroidectomy after first goiter operations. In this article we analyze results of patients undergone thyroidectomy for recurrent goiter. Material and method: Records of patients that have undergone thyroidectomy for recurrent goiter are investigated retrospectively. Results: Thirteen patients operated for recurrent goiter. All of them was female. Transient hypocalcemia was developed 4 (31%) patients. Additional complications were not observed. Discussion: For prevention of recurrent goiter, first operation must be total thyroidectomy. Although complications are higher in recurrent surgery when compared with first operation, this operation can be performed with lower morbidity rates by experienced surgeons. [ABSTRACT FROM AUTHOR]

Carcinosarcoma of the breast represents less than 1% of primary breast mailgnancies. Both malign epithelial and malign mesenchymal elements exist together in the breast. A 59 year old postmenopausal women presents with a bloody nipple discharge and mass in breast. In left breast 2x1 cm mss detected and excisied. At pathological examination breast carcinosarcoma was detec-ted. Then modified radical mastectomy was performed. Tumor measured 4x4x3.5 cm. Tumor cells were negative for estrogen, progesteron. C-erb-B2 was negative. There was no metastasis in axillary lymph node metastasis. Carcinosarcoma of breast is rare tumor. It mass be consider in diagnosis of patients with large breast mass. [ABSTRACT FROM AUTHOR]

Objective: Although all animal studies are conducted in line with a specific purpose, we think that not all animal studies are performed for a scientific purpose but for personal curiosity or to fulfill a requirement. The aim of the present study is to reveal the purposes of experimental studies conducted on animals., Matherial and Methods: We searched for experimental studies performed on rats in general surgery clinics via PubMed, and obtained the e-mail addresses of the corresponding authors for each study. Afterwards, we sent a 7-item questionnaire to the authors and awaited their responses., Results: Seventy-three (22.2%) of 329 authors responded to the questionnaire. Within these studies, 31 (42.5%) were conducted as part of a dissertation, while the remaining 19 (26.0%) were conducted to meet the academic promotion criteria. Only 23 (31.5%) were conducted for scientific purposes. The cost of 41% of those studies was higher than 2500 $., Conclusion: As shown in this study, the main objective of carrying out animal studies in Turkey is usually to prepare a dissertation or to be entitled to academic promotion. Animal experiments must be planned and performed as scientific studies to support related clinical studies. Additionally, animal studies must have well-defined objectives and be carried out in line with scientific purposes that may lead to useful developments in medicine, rather than personal interests., Competing Interests: No conflict of interest was declared by the authors.

Objective: A dissertation is a scientific document. However, if it is not published in a scientific journal, it will gain access to only a limited audience and thus will be unable to achieve its objective. Nevertheless, the rate of publishing in journals is not high among dissertations. In this study, we aimed to investigate the publishing rates of general surgery dissertations in journals and the total number of citations., Material and Methods: All medical dissertations that have been prepared at general surgery departments of university hospitals and presented between the years 2006 and 2008 were analyzed. The authors checked whether the dissertations were published in a journal or not, by searching the dissertation in 4 different resources with the name of their authors., Results: Two hundred and thirty-two dissertations were included. Half of those dissertations were experimental animal studies. Seventy dissertations were published in various journals. Fifty one (22%) of these were published in Science Citation Index Expanded journals, while 19 (8.1%) of them were published in Turkish non-Science Citation Index Expanded journals. There was no significant difference in terms of publishing rates between study types. The number of annual citations per article was 1.1. The writer of the dissertation was the first author in 35 (68,6%) articles., Conclusion: The publishing rates of dissertations in general surgery is low, with only 22% being published in Science Citation Index Expanded journals. The citation rate was also detected to be low in our study. Consequently, a dissertation should be considered as a scientific research study and planned as such, not as obligatory assignments. The publishing rates of dissertations should be increased, and authors should be led and encouraged to publish their dissertations., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.