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Obesity is associated with heart rhythm disturbances. Synchrony between the electrical and mechanical activities of the heart is adversely affected in people with obesity. In this study, the authors aimed to show the effect of amount of weight loss after weight loss surgery on the coupling properties of electrical and mechanical activities of heart chambers called atria. The authors included 41 participants. Heart ultrasound was done before and after weight loss surgery. Statistical analyses were performed to show the effect of total body weight loss on the heart's electrical and mechanical atrial functions. Significant weight loss was observed in participants during short-term follow-up after surgery and was found to be related to the electrical and mechanical functions of the atria. In the authors' study, weight loss achieved in the short term after weight loss surgery improved the electrical and mechanical coupling of the atria. This may translate into decreased rhythm disturbance risk in these patients.

Objective: Bariatric surgery has been shown to improve cardiac structure and function in obese patients. This study was an examination of the short-term effects of sleeve gastrectomy on body measurements and diastolic function. Methods: A total of 41 consecutive obese patients who were scheduled to undergo a sleeve gastrectomy procedure were included in the study. Baseline body and echocardiographic measurements and the follow-up counterpart data, including total and excess weight loss percentages, were recorded. Results: The mean age of the patients was 42.85±11.47 years. Of the total, 21 (51.1%) patients were female. The mean body mass index (BMI) was 44.86±5.62 kg/m2. The mean duration of follow-up was 91.24±44.48 days. The participants demonstrated statistically significant weight loss (26.64±10.95 kg), as well as a decrease in BMI (8.84±3.93 kg/m2) and body surface area (0.27±0.12 m2). A significant increase in E velocity and mitral annular e velocity were observed, as well as a significant decrease in A velocity, E/e ratio, left ventricle mass, and left atrial volume (LAV). No significant correlations between the body measurement changes and changes in echocardiographic parameters were observed, with the exception that the excessive weight loss percentage was moderately correlated with a change in LAV. Conclusion: Sleeve gastrectomy led to a significant decrease in body weight and improved diastolic function parameters in the short-term. No significant relationship was found between the amount of weight loss and change in echocardiographic measurements. © 2018 Turkish Society of Cardiology.

To evaluate respiratory function in the post-operative early period of patients undergoing bariatric surgery using the sleeve gastrectomy technique.This prospective, observational study was conducted at Bülent Ecevit University Health Application and Research Centre, Zonguldak, Turkey from June to December 2014, and comprised patients with planned bariatric sleeve gastrectomy under general anaesthesia. Participants were visited 12-24 hours before the operation to record accompanying diseases and demographic data. Before the operations, respiratory function test, maximum expiratory pressure, maximum inspiratory pressure and arterial blood gas assessment tests were done and recorded as T0. After one hour of the operation, Aldrete scores9 and the above-mentioned tests were repeated and recorded as T1. SPSS 18 and MedCalc 12.2.1.0 were used for statistical analysis.Of the 76 participants, 60(78%) were women and 16(21%) were men. The overall median age was 39 years (inter-quartile range: 32-47 years). The mean and median values for forced expiratory volume in 1 second, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure and the ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen at T0 were 101±17, 102±17, 66 (interquartile range: 59-74), 114 (interquartile range: 100-138) and 379±49, respectively, compared with 78±18, 76±18, 53 (interquartile range: 48-59), 85 (interquartile range: 73-95) and 331±49at T1 (p0.001 each). Also, 38(50%) participants were given sugammadex and 38(50%) were given neostigmine. At the end of the test, sugammadex (odds ratio: 5.80; 95% confidence interval: 1.26-26.69; p=0.024) and pre-operative ratio between partial pressure of oxygen in arterial blood and fraction of inspired oxygen (odds ratio: 1.04, 95% confidence interval: 1.02-1.06; p0.0001) were found to correlate significantly.Impairment of respiratory function was found during the early post-operative period.

Background Intraoperative ultrasound guided (IUG) breast conserving surgery (BCS) is being increasingly embraced by breast surgeons worldwide. We aimed to compare the efficacy of IUG-BCS for palpable and nonpalpable breast cancer with respect to margin status, re-excision rate, tissue sacrifice and cost-time analysis. Methods Intraoperative localization protocol includes intraoperative ultrasound prior to excision to localize the lesion and guide the initial resection. The excised specimen was then examined visually and by palpation and the specimen and cavity was examined with ultrasound. Frozen sections were obtained routinely from a portion of all six faces of the resected specimen, and shaved cavity margins were sent for permanent histology. Results Of the 208 patients, 57.2% had nonpalpable tumors. The sensitivity of ultrasound localization was 100%. Negative margins were achieved in 92.43% of nonpalpable and 91.01% of palpable lesions at initial procedure. The involved margins were correctly identified by the surgeon via specimen sonography in 95.4% of cases. Final positive margin rate was 2.4%. Calculated resection ratio and time analysis revealed nothing significant. Conclusion IUG-BCS is an invaluable and effective modality for obtaining clear surgical margins with optimum resection volumes and reducing re-operations. Furthermore, by means of this algorithm, in case of shaving cavity margins of the tumor bed for permanent analysis, frozen section evaluation might be omitted.

Previously we described the technique to lessen complications of continuous ambulatory peritoneal dialysis (CAPD) and to achieve immediate use of the catheter. In this study we evaluated our long-term results of the technique. A total of 61 procedures were carried out in 58 patients from September 2003 to February 2009. All patients were followed in our hospital CAPD clinic. Demographic, medical, operative, postoperative, and other information regarding complications and continued patient management was obtained retrospectively from the patients’ medical records and entered into a computerized database. There were 33 men and 25 women. The mean age was 58 years. In 29 of the 58 patients indication of catheter placement was end stage renal failure combined with diabetes mellitus. Mean follow-up time was 33.31 ± 20.11 months. Catheter related complications were outflow obstruction (n = 3, 5.2%) and peritonitis (n = 2, 3.4%). Etiologies of catheter removal were out flow obstruction (n = 2), recovery from renal disease (n = 2), peritonitis (n = 1), and pregnancy (n = 1). The mean catheter survival time was found 5.57 ± 0.17 years. Our long-term results showed that the method ensured accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. Preperitoneal fixation of the catheter decreased outflow obstruction over long-term follow-up.

Background Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention. Objective To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach. Methods Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability. Results Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe. Conclusion Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach. J. Surg. Oncol. 2013;107:206–210. © 2012 Wiley Periodicals, Inc.

Background/purpose: Despite decades of research and clinical trials, a specific therapeutic treatment for acute pancreatitis (AP) has yet to be developed. The aim of the present study was to investigate the effects of erythropoietin on the severity of taurocolic acid-induced acute necrotizing pancreatitis. Methods: Forty-seven male Wistar albino rats were randomized into seven experimental groups. In group I, animals were sham-operated (n = 5). In groups II, III, IV, IIepo, IIIepo, and IVepo, AP was induced by sodium taurodeoxycholate treatment (n = 7). In groups II, III, and IV, 1 ml normal saline and in groups IIepo, IIIepo, and IVepo, 1000 U/kg body weight erythropoietin (EPO) was administered intramuscularly immediately after the induction of AP. Animals were killed at 24, 48, and 72 h postoperatively. Histopathological and biochemical evaluations were performed. Results: The serum levels of interleukin-6 (IL-6) and tissuelevels of malondialdehyde were found to be significantly lower in EPO-administered groups when compared with the levels in groups without EPO treatment. The severity of pancreatic edema, acinar necrosis, inflammation, and perivascular infiltrate were reduced in all the EPO groups compared with the no-treatment groups. Conclusions: Our findings may reflect the possible cytoprotective effect of EPO in acute necrotizing pancreatitis. © Springer 2009.

Introduction: Sildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis. Methods: Thirty-six male Wistar albino rats were randomized into four experimental groups (n = 9 in each group). In group 1, a well-perfused left colonic segment was transected, and free ends were anatomosed. In groups 2, 3 and 4 animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. Group 2 animals received only tap water. In groups 3 and 4 animals received 10 mg/kg/body-weight and 20 mg/kg/body-weight sildenafil, single dose a day during 4 days, respectively. Rats were sacrificed on day 4 following operation. Anastomotic integrity, intra-peritoneal adhesion scores, anastomotic bursting pressures and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. Results: There was no statistically significant difference among groups with respect to anastomotic integrity (p = 0.142) but ischemia decreased the anastomotic bursting pressure. The mean bursting pressure values were 78.8 ± 24.1, 43.3 ± 26, 55.1 ± 32.4, and 43.3 ± 20.4 in groups 1, 2, 3, and 4, respectively. Group 1 had the highest values whereas; there was no statistically significant difference between groups 1 and 3. There was no statistically significant difference among groups 2, 3, and 4 with respect to tissue hydroxyproline levels, adhesion scores and the Chiu scores. The highest inflammatory cell presence in the granulation tissue was detected in group 2, whereas the lowest was detected in group 4 (p = 0.0001). The highest fibroblast infiltration in the granulation tissue was detected in group 1 (p = 0.045). Discussion: Our results showed that 10 mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models. © 2008 Surgical Associates Ltd.

WOS: 000271092000006, PubMed: 19842890, Introduction: Resveratrol (RSV) is a natural polyphenolic compound found in grape skins and the red wine which improves histological reorganization of the regenerating tissue in dermal wound healing. Since anastomotic healing possesses paramount importance to prevent complications in colorectal surgery, the present study is aimed to evaluate the effect of RSV on the healing of experimental left colonic anastomoses. Methods: Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with RSV and the control group received tap water instead. The rats were sacrificed 3 and 7 days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline (OHP) content, histopathology, and biochemical analysis. Results: Compared to the control group, the RSV-treated rats displayed a higher bursting pressure (p < .001) and anastomotic OHP content (p < .05)]. RSV treatment leads to significant increase in PON activity at both time points and decrease in malondialdehyde levels on postoperative day 3 (p < .001). Histopathological analysis revealed that RSV administration leads to a better anastomotic healing in terms of mucosal ischemia, neovascularization, reepithelialization, fibroblast, and lymphocyte infiltration. Conclusion: The study results suggest that exogenous RSV administration exerts a positive effect on experimental colonic wound healing in the rat. Although the precise cellular mechanisms by which RSV enhances anastomotic wound healing is not clear, stimulation of neovascularization, generation of collagen synthesis, inhibition of overinflammation, and restriction of oxidative injury seems to be of paramount importance.

Mounting evidence suggests that impaired wound healing is a well-defined consequence in obstructive jaundice and, as redox-regulated processes are relevant to wound healing, it is not unreasonable to suppose that oxidative stress associated with lipid peroxidation in cholestasis might be a systemic phenomenon probably comprising all tissues and organs, including wounds. The aim of the present investigation was to analyse the lipid peroxidation status of surgical wounds, in terms of oxidized low-density-lipoprotein (oxLDL) accumulation in experimental obstructive jaundice.Sixteen Wistar-Albino rats weighing 200-230 gr were randomly divided into two groups. Group I (n = 8) was designed as the prolonged obstructive jaundice group and was subjected to bile duct ligation. Group II (Sham-control, n = 8) rats underwent laparotomy alone and bile duct was just dissected from the surrounding tissue. Histopathological evaluation, immunohistochemical screening and immunoflourescent staining of the surgical wound was conducted to the bile-duct ligated rats and control group on the 21st postoperative day.Wound healing was found to be impaired in jaundiced rats histopathologically. When compared with the control group, significant positive oxLDL staining and intracellular accumulation of TNF-alpha, IL-2 and IL-6 was detected in the wound sections of the prolonged obstructive jaundice group.Our present data is the first in the literature, indicating significant oxLDL accumulation in surgical wounds of cholestatic rats, which might be one of the results of systemic oxidative stress leading to deficient healing capacity as a consequence of persistent inflammation.

3rd European Meeting on Molecular Diagnostics -- 37910 -- Scheveningen, NETHERLANDS, WOS: 000239295700002, PubMed: 16865564

PURPOSE: Cases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period. METHODS: In this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6-44) months after wide excision plus classic Limberg flap (Group 1, n = 35) and after asymmetric modified Limberg flap closure (Group 2, n = 33). RESULTS: There were significantly more macerations in Group 1 (P < 0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P = 0.028). We noted that as a result of these complications, time to suture removal (P = 0.001), discharge from hospital (P = 0.001), and time off from work (P = 0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P = 0.493). CONCLUSIONS: The deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line. © The American Society of Colon and Rectal Surgeons.

Access to the gastric lumen can be achieved by different methods. Orogastric tubes and tube gastrostomies are frequently used but these routes have some disadvantages when recurrent gastric intubations or infusions are concerned. The Janeway gastrostomy tube is a simple-to-perform procedure and can serve as an excellent way to reach the gastric lumen of animals. It is also possible to insert large caliber devices such as cameras to examine the gastric lumen. Plugging of the pylorus is also possible with Fogarty catheters either blind or under radiological guidance. The Janeway gastric tube seems to be useful for long-lasting gastrointestinal procedures, for example gastric cancer studies. © 2007 Springer Science+Business Media, LLC.

A 29-year-old man presented to the gastroenterology department, Bulent Ecevit University Hospital, with one week history of continous abdominal pain in the epigastric and right upper quadrant of the abdomen. The pain was unrelated to food consumption, and there was accompanying nausea but no vomiting. His past medical history was uneventful. On physical examination, the patient was alert and oriented. His temperature was 36.7oC, he had a regular pulse which measured 78 beats/min, and his blood pressure was 120/70mmHg. There was epigastric tenderness on deep palpation. There was no guarding and no rebound tenderness. His respiratory and cardiovascular system examinations were normal. Laboratory investigations revealed: C-reactive protein 13.2mg/L (0–8mg/L normal), serum alanine transaminase 378U/L (10–49U/L normal), serum aspartate aminotransferase 405U/L (120–246U/L normal), serum gamma-glutamyl transpeptidase 591U/L (0–73U/L normal), serum lactate dehydrogenase 348U/L (120–246U/L normal), serum alkaline phosphatase 158IU (80–280IU normal), total biluribin 2.0mg/dL (0.3–1.2mg/dL normal), amylase 32U/L (30–118U/L normal), and lipase 24U/L (6–51 U/L normal). The results of a complete blood count, electrolyte panel, and renal function tests were normal. An abdominal ultrasonography showed a well-demarcated anechoic cystic lesion, 75mm in diameter with multiple septations in the left liver lobe. Magnetic resonance imaging and magnetic resonance cholangiopancreatography were also performed [Figure 1 and 2]. Figure 1 Sagittal (a) and axial (b) T2-weighted magnetic resonance imaging revealed hyperintense cystic lesion with hypointense rim in the liver. Figure 2 Magnetic resonance cholangiopancreatography revealed cystic lesion and biliary system.

Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention.To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach.Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability.Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe.Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach.

Aim: This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on anastomotic healing of irradiated rats. Methods: Thirty-two male Wistar albino rats were randomized into four groups containing 8 rats each: I; standard resection plus anastomosis, II; radiation plus standard resection plus anastomosis, III; radiation plus standard resection plus anastomosis plus oral NAC, IV; radiation plus standard resection plus anastomosis plus intraperitoneal NAC. Four types of assessment were performed: bursting pressure, hydroxiproline (OHP) content, histopathology, and biochemical evaluation, including serum malondialdehyde (MDA), advanced oxidation protein products (AOPP), reduced glutathione (GSH) and superoxide dismutase (SOD) activities. Results: Group comparisons demonstrated that bursting pressure was significantly higher in NAC treated rats. The mean tissue OHP concentration in the anastomotic tissue was significantly lower in irradiated rats (group II) than in the other groups. NAC treatment caused increased activity of SOD and GSH. In contrast, MDA levels were found to be decreased in groups III and IV. Histopathological analysis revealed that NAC administration, either orally or intraperitoneally, leads to a better anastomotic healing in terms of reepithelialization, perianastomotic fibrosis, ischemic necrosis, and muscle layer destruction. Conclusion: The present study supports the hypothesis that NAC administration alleviates the negative effects of radiotherapy on anastomotic healing. Nevertheless, the underlying mechanisms responsible for this protective effect is unknown today. © 2011 Informa Healthcare USA, Inc.

The reasons of post-stroke infections are still incompletely understood. Bacterial translocation (BT), the passage of viable microbes across an even anatomically intact intestinal barrier, has been described in many critical illnesses. To date, it has not been studied as a source of infection in an animal stroke model. To address this, a permanent left middle cerebral artery occlusion (MCAO) model in rats was used. After 24, 48, and 72 hours (h), sham and experimental groups were sacrificed and samples were taken for BT. Similarity between bacteria detected in tissues (blood, mesenteric lymph node, liver, spleen, and lung) and intestinal microflora was shown with phenotypic methods and antibiotyping. Possible ileum tissue injuries were shown by histopathologic examination (including morphometric analysis). Although there was no bacterial proliferation in the sham groups, 55.5%, 45.4%, and 30% bacterial proliferation was detected in MCAO groups at postoperative hour 24, 48, and 72, respectively. In MCAO groups the bacterial proliferation in tissues and ileum tissue injury scores were higher over time compared to sham groups (p0.05). Our findings support the view that stroke, itself leads to mucosal damage and bacterial translocation (Tab. 5, Fig. 2, Ref. 27).

Annual Congress on Turkish National Surgery -- MAY, 2008 -- Antalya, TURKEY, WOS: 000268575000024, PubMed: 19578821, Simvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor commonly known as a cholesterol-lowering drug with additional pleiotropic effects. Also, it is demonstrated that it prevents postoperative peritoneal adhesions in rat. This study was designed to assess its effects on the healing process of colonic anastomosis. Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with simvastatin and the control group received only tap water instead. The rats were killed 3 and 7 days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline content, histopathology, and biochemical analysis. Compared to the control group, simvastatin-treated rats displayed a higher bursting pressure (p < 0.001) and anastomotic hydroxyproline content (p < 0.05). Simvastatin treatment leads to a significant decrease in malondealdehyde levels (p < 0.05) and increase in paraoxonase activity (p < 0.001) at both time points. Histopathological analysis revealed that simvastatin administration leads to a better anastomotic healing in terms of reepithelialization, decreased granuloma formation, reduced ischemic necrosis, and inflammatory infiltration to muscle layer. Clinically relevant doses of simvastatin do not have a negative impact on colonic anastomosis but improve intestinal wound healing in rats.

AIM: To investigate the gastroprotective effect of vardenafil against indomethacin-induced gastric damage. METHODS: Forty-eight female Wistar albino rats were randomly divided into 6 groups. Group 1 received saline only. Group 2 (indomethacin) received indomethacin. Rats in group 3 and 4 were pretreated with different doses of famotidine. Group 5 and 6 were pretreated with different doses of vardenafil. Rats in groups 3 to 6 received 25 mg/kg indomethacin 30 min after pretreatment. The animals were sacrificed 6 h later and their stomachs were opened. Gastric lesions were counted and measured. The stomach of each animal was divided in two parts for histopathological examinations and nitric oxide (NO) and malondialdehyde (MDA) assays, respectively. RESULTS: There were no gastric mucosal lesion in the saline group but all rats in the indomethacin group had gastric mucosal ulcerations (ulcer count; 6.25 ± 3.49, and mean ulcer area; 21.00 ± 12.35). Ulcer counts were diminished with famotidine 5 mg/kg (4.12 ± 2.47, P > 0.05), 20 mg/kg (2.37 ± 4.43, P < 0.05), vardenafil 2 mg/kg (4.37 ± 3.06), and vardenafil 10 mg/kg (1.25 ± 1.38, P < 0.05) compared to the indomethacin group. Gastric mucosal lesion areas were diminished with famotidine 5 mg/kg (8.62 ± 2.97, P < 0.001), famotidine 20 mg/kg (0.94 ± 2.06, P < 0.001), vardenafil 2 mg/kg (6.62 ± 5.87, P < 0.001), and vardenafil 10 mg/kg (0.75 ± 0.88, P < 0.001) compared to the indomethacin group. MDA levels were significantly higher in indomethacin group (28.48 ± 14.51), compared to the famotidine 5 mg/kg (6,21 ± 1.88, P < 0.05), famotidine 20 mg/kg (5.88 ± 1.60. P < 0.05), vardenafil 2 mg/kg (15.87 ± 3.93, P < 0.05), and vardenafil 10 mg/kg (10.97 ± 4.50, P < 0.05). NO concentration in gastric tissues of the famotidine groups were significantly increased (P < 0.05), but the NO increases in the vardenafil groups were not statistically significant. Histopathology revealed diminished gastric damage for pretreatment groups compared to the indomethacin group (P < 0.05). CONCLUSION: Vardenafil affords a significant dose-dependent protection against indomethacin induced gastric mucosal lesions in rats. © 2009 The WJG Press and Baishideng. All rights reserved.

WOS: 000266280200006, PubMed: 19466656, Introduction: 2-octyl-cyanoacrylate may be a good alternative in ischemic colon anastomosis without impairment of tissue perfusion. Methods: Forty male Wistar albino rats were randomized into four experimental groups (n = 10 in each group). In group 1 (control), a well-perfused left colonic segment was transected, and free ends were anastomosed by propylene sutures. In groups 2, 3, and 4, the animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. In group 2, an end-to-end anastomosis was created using six interrupted 6-0 polypropylene sutures between ischemic edges. In group 3, after approximating the mesenteric and antimesenteric edges of the anastomosis with two 6-0 polypropylene sutures, 2-octyl-cyanoacrylate was applied between the edges. In group 4, anastomosis was created by the same technique as described in group 2, and additionally 2-octyl-cyanoacrylate was applied on suture line. Rats were killed on day 4 following operation. Anastomotic integrity, intraperitoneal adhesion scores, anastomotic bursting pressures, and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. Results: There were no statistically significant differences among groups with respect to anastomotic integrity (p =.142). The mean bursting pressure values were 81.1 23.83, 43.3 26.06, 15.8 11.3, and 17.6 18.02 in groups 1, 2, 3, and 4, respectively. There were no statistically significant differences among groups 2, 3, and 4 with respect to tissue hydroxyproline levels and bursting pressure levels. The highest adhesion scores were observed in groups 3 and 4. Discussion: 2-octyl cyanoacrylate does not have additional advantages in the healing of experimental ischemic colon anastomosis.

WOS: 000266280200008, PubMed: 19466658, Introduction: Hemorrhage is a leading cause of death after trauma. It is also the major cause of operating room deaths among patients who undergo liver surgery. Various techniques and materials have been attempted to manage bleeding, but a standard method has not been defined yet. We studied the hemostatic effects of Ankaferd Blood Stopper on liver injury in comparison with regenerated oxidized cellulose. Materials and Methods: Thirty Wistar albino rats underwent partial hepatic laceration by scissors. The animals were randomized to the treatment of resected surface with either Ankaferd Blood Stopper (ABS, n = 11) or regenerated oxidized cellulose (Surgicel, n = 9), or were left untreated (controls, n = 10). All the animals were resuscitated with lactated Ringer's solution at 3.3 ml/min/kg to a mean arterial pressure (MAP) of 100 mmHg. Survival time, total blood loss, resuscitation volume, and MAP were recorded for 30 min or until death. The rats that were alive at the end of 30 min were sacrificed with blood withdrawal from catheters. Results: Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (p =.0001). There were no significant differences between the ABS and the Surgicel groups in survival (p =.91). Application of ABS and Surgicel was associated with a significant reduction in blood loss compared to controls (p =.008), with no significant differences between active treatment groups (p =.74). The resuscitation volume was not different. Conclusions: ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

The mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute appendicitis-like symptoms. Sometimes, patients with mucocele can present with confusing symptoms. Preoperative suspicion and diagnosis of appendiceal mucocele are important. Ultrasonography and camputed tomography are useful tools for the diagnosis of appendiceal mucocele. It may be also recognised by colonoscopy as a smooth submucosal lesion of the cecum. Optimal management of the mucocele could be achieved through accurate preoperative diagnosis. Preoperative diagnosis is a major component for minimizing intra-operative and post-operative complications. We herein report five cases and discuss the diagnostic methods and surgical treatment. © 2008 WJG. All rights reserved.

Bezoars are foreign bodies that form masses in the gastric or intestinal lumen, particularly in mentally retarded or psychiatric patients.1 Classifications of bezoars are made according to the content of the bezoar, such as trichobezoars (of hairs), phytobezoars (of vegetable fibers), lactobezoars (of milk products), and others containing medications or other foreign materials.2 Whatever the etiology, the usual location of bezoar formation is the stomach; the addition of new materials to this nidus increases the size of the bezoar. On very rare occasions, part of the parent mass extends as a tail into the intestine. Due to the similarity of the tail of the bezoar to the hair of the female prisoner in a fairy tale by the Grimm brothers, this condition has been named the Rapunzel Syndrome.3

Purpose. Surgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups. Methods. Between April 2001 and May 2007, 144 patients underwent TT at our hospital. For 75 operations, the primary surgeon was a resident under the direct supervision of the attending surgeon, and for 69 operations, the primary surgeon was the experienced attending surgeon. Pre-and postoperative vocal cord examinations and serum calcium level evaluations were carried out in all patients. Results. The rates of temporary (unilateral) recurrent laryngeal nerve (RLN) palsy were 2.66% vs 2.17% after TT performed by the residents vs the attending surgeon, respectively. There were no significant differences in the incidences of temporary hypoparathyroidism (20% vs 20.28%), permanent (unilateral) RLN palsy, hematoma, infection, seroma, and incidental parathyroidectomy between the two groups. Conclusion. The complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance. © 2008 Springer.

WOS: 000255955700024, PubMed: 17932755, Introduction Sildenafil both enhances vasodilatation by relaxing the smooth muscle in the vessels and inhibits platelet aggregation. We have therefore examined the potential benefits of sildenafil on an animal model for ischemic colitis (IC). Methods Twenty-eight female Wistar albino rats weighing 250-300 g were randomized into three experimental groups as follows: in Group 1, animals were sham operated (n = 8) and received tap water; in Groups 2 and 3, the rats underwent a standardized surgical procedure to induce IC (n = 10 in each group). Group 2 animals served as the controls, receiving only tap water, while Group 3 animals received 10 mg/kg sildenafil per day as a single dose for a 3-day period. All animals were sacrificed 72 h after devascularization. To determine the severity of the ischemia, we scored the macroscopically visible damage, measured the ischemic area and scored the histopathology. Tissue malondialdehyde levels were also evaluated. Results The mean area of ischemic changes were 116.80 +/- 189.93 and 0.55 +/- 1.01 mm(2) in Group 2 and 3 animals, respectively (p = 0.0001), while the macroscopically mean visible damage score decreased to 0.66 +/- 0.70 (p = 0.0001) for Group 3 animals. The Chiu scores were 0.00, 3.80 +/- 0.91 and 2.66 +/- 1.00 in Group 1, 2 and 3 animals, respectively. There was a statistically significant difference between Group 2 and 3 animals (p = 0.017). Conclusions Our findings support the view that sildenafil leads to a improvement in IC due to its well-known effects on the vascular smooth muscle and on the microcirculatory hemodynamics.

WOS: 000258504600027, PubMed: 18719774

To review our own experience with fine needle aspiration biopsy (FNAB) and frozen section (FS) in thyroid surgery and to assess the value of FNAB and FS in predicting malignancy in patient with thyroid disease.The records of 300 patients who underwent thyroid surgery between April 2001 and June 2006 were analyzed.Of the 153 patients who had preoperative FNABs performed, 8 (5.22%) were reported as indeterminate, 100 (65.35%) were read as benign, and 3 (1.96%) were read as malignant. Fourty two of the FNABs were inadequate for evaluation (27.45%). When occult papillary carcinomas were excluded, sensitivity, and accuracy rates for FNAB reached 100%. One hundred and ninety one patients had FSs performed. 184 (96.33%) of these were reported as benign, 4 (2.09%)were reported as malignant, 3 (1.57%) were deferred to permanent paraffin (PP) sections. When occult papillary carcinomas were excluded, sensitivity, and accuracy rates for FS were 42.85%, 43%, and 97.28% respectively.Our data supports the use of FNAB in the confirmation of malignancy and the need for operation. The routine use of FS is not warranted. Selective use of FS when FNAB is nondiagnostic or indeterminate may provide additional information. Both FNAB and FS fail to reveal occult carcinomas of thyroid.

Background/Aims. The aim of this study was to identify oxidative damage of kidney during ischemia reperfusion injury (IRI) by evaluating changes in lipid peroxidation markers in tissue and blood by an experimental model. Oxidized LDL (ox-LDL) was used as an oxidative stress biomarker, whereas paraoxonase (PON-1) activity was used as an antioxidative biomarker. Methods. Sixty-three male Wistar rats were randomly assigned into three groups: renal IRI, sham, and control. In the renal IRI group, the right kidney was removed and the artery and vein of the left kidney were clamped for 90 minutes. The presence of ox-LDL in the kidney tissue sections was determined by using an immunofluorescent staining method. Results. The plasma ox-LDL levels did not increase significantly at the 24th hour following IRI, made a peak at the 48th hour, and declined at the 72nd hour. Accumulation of ox-LDL was detected in the kidney tissue on the 24th, 48th, and 72nd hours of the renal IRI. Serum PON-1 levels have peaked on the 24th hour and then declined. Conclusion. This study demonstrates the accumulation of ox-LDL molecules in the renal tissues of the IRI model. Future strategies aimed to reduce the lipid peroxidation during the initial hours of renal IRI may be useful to prevent complications of ischemia. Copyright © Informa Healthcare.

Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the fi rst case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.

WOS: 000251840200007, PubMed: 18069756, AIM: To investigate the effect of exogenous erythropoietin (EPO) administration on acute lung injury (ALI) in an experimental model of sodium taurodeoxycholate-induced acute necrotizing pancreatitis (ANP). METHODS: Forty-seven male Wistar albino rats were randomly divided into 7 groups: sham group (n = 5), 3 ANP groups (n = 7 each) and 3 EPO groups (n = 7 each). ANP was induced by retrograde infusion of 5% sodium taurodeoxycholate into the common bile duct. Rats in EPO groups received 1000 U/kg intramuscular EPO immediately after induction of ANP Rats in ANP groups were given 1 mL normal saline instead. All animals were sacrificed at postoperative 24 h, 48 h and 72 h. Serum amilase, IL-2, IL-6 and lung tissue malondialdehyde (MDA) were measured. Pleural effusion volume and lung/body weight (LW/BW) ratios were calculated. Tissue levels of TNF-alpha, IL-2 and IL-6 were screened immunohistochemically. Additionally, ox-LDL accumulation was assessed with immune-fluorescent staining. Histopathological alterations in the lungs were also scored. RESULTS: The mean pleural effusion volume, calculated LW/BW ratio, serum IL-6 and lung tissue MDA levels were significantly lower in EPO groups than in ANP groups. No statistically significant difference was observed in either serum or tissue values of IL-2 among the groups. The level of tumor necrosis factor-alpha (TNF-alpha) and IL-6 and accumulation of ox-LDL were evident in the lung tissues of ANP groups when compared to EPO groups, particularly at 72 h. Histopathological evaluation confirmed the improvement in lung injury parameters after exogenous EPO administration, particularly, at 48 h and 72 h. CONCLUSION: EPO administration leads to a significant decrease in ALI parameters by inhibiting polymorphonuclear leukocyte (PMNL) accumulation, decreasing the levels of proinflammatory cytokines in circulation, preserving microvascular endothelial cell integrity and reducing oxidative stress-associated lipid peroxidation and therefore, can be regarded as a cytoprotective agent in ANP-induced ALI. (c) 2007 WJG. All rights reserved.

WOS: 000260451400201, PubMed: 17957635

WOS: 000235059700029, PubMed: 16333536, Background: Postoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery. Methods: Thirty patients with unilateral inguinal hernia who had a hernia sac of > 4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month. Results: USG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups. Conclusions: Superficial USG is a beneficial tool in differentiating early recurrence or seroma In patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.

Background: Laparoscopic cholecystctomy has become the treatment of choice for symptomatic gallstones. The potential risks have dissuaded some surgeons from using the laparoscopic procedure in patients with previous abdominal surgery. Therefore, we aimed to investigate the effect of previous abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. Methods: This study included 600 well-documented patients with gallstones who underwent laparoscopic cholecystctomy at our surgical department between May 2000 and January 2004. The patients were classified into 3 groups: group 1, patients without a history of previous abdominal surgery (n=408); group 2, patients with a history of upper abdominal surgery (n=92); group 3, patients with a history of lower abdominal surgery (n=100). The data were collected and analyzed for open conversion rates, operative times, perioperative and postoperative complications, and hospital stay. Results: Of the 600 study patients, 192 had undergone previous abdominal surgery (92 upper, 100 lower). Conversion rate, hospital stay, and complication rates were similar in each group. Mean operating time was the longest (57±9.8 min) in patients with previous upper abdominal surgery (P0.05). Conclusion: Previous abdominal surgery is not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with a prolonged operation time.

levels, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and mortality. Method and Patients: A total of 45 patients with intra-abdominal sepsis from the General Surgery Intensive Care Units of Gazi University School of Medicine and Zonguldak Karaelmas University School ofMedicinewere included in the study. Eighteenwith sepsis, 14 patients with severe sepsis, and 13 with septic shock were investigated. After the diagnosis of sepsis, blood samples were taken on the next 5 days. All patients were followed for 28 days and mortalities were noted. Adiponectin and cytokine levels and routine biochemistry were measured daily during the first 5 days after admission and were correlated to other cytokines, APACHE II scores, and mortality. Results: Forty-five patients were studied, 12 of whom died within 28 days. Although serum adiponectin levels were significantly higher than in the control group, the levels of septic shock and severe sepsis were significantly lower than in the septic patients. Serum adiponectin levels negatively correlated with interleukin-6, interleukin-1β, tumor necrosis factor-α, procalsitonin, lactate, and APACHE II. Serum adiponectin levels of the dead patients were significantly lower than those of surviving patients. Conclusions: Serum adiponectin levels in patients with intraabdominal sepsis were negatively correlated with proinflammatory cytokines and APACHE II levels. It can be used as a strong negative predictive factor for mortality.

WOS: 000240185800025, PubMed: 16937511, Even lipomas are the most common mesenchymal benign tumors of the gastrointestinal tract, symptomatic colonic presentation is rare. Herein, we evaluated four patients suffering from various size of colonic lipomas and approached by different therapeutic modalities. (C) 2006 The WJG Press. All rights reserved.

WOS: 000249901500008, PubMed: 17907291, AIM: To evaluate the frequency of neural cell adhesion molecule (NCAM)-180 expression in fresh tumor tissue samples and to discuss the prognostic value of NCAM-180 in routine clinical practice. METHODS: Twenty-six patients (16 men, 10 women) with colorectal cancer were included in the study. Fresh tumor tissue samples and macroscopically healthy proximal margins of each specimen were subjected to flow-cytometric analysis for NCAM-180 expression. RESULTS: Flow-cytometric analysis determined NCAM-180 expression in whole tissue samples of macroscopically healthy colorectal tissues. However, NCAM-180 expression was positive in only one case (3.84%) with well-differentiated Stage II disease who experienced no active disease at 30 months follow-up. CONCLUSION: As a consequence of the limited number of cases in our series, it might not be possible to make a generalisation, nevertheless the routine use of NCAM-180 expression as a prognostic marker for colorectal carcinoma seems to be unfeasible and not cost-effective in clinical practice due to its very low incidence. (C) 2007 WJG. All rights reserved.

WOS: 000349275900010, PubMed: 25666963, Introduction: Alcohol consumption is frequently associated with gastric mucosa! lesions. The purpose of this study was to determine the effect of Coenzyme-Q(10) (CoQ(10)) supplementation on the ethanol-induced gastric mucosal damage in a rat model. Material and method: Sixty-four female wistar albino rats were randomly divided into 8 groups (n = 8). Studies were performed in ethanol induced gastric ulcer model in Wistar albino rats. Famotidine at a dose of 5 mg/kg or 20 mg/kg and CoQ(10), at a single dose of 10 mg/kg or 20 mg/kg and 30 mg/kg for 7 days were administered as pretreatment. All the rats in study groups received 2 ml/kg ethanol 95 % intragastrically, 30 minutes after pretreatment. Four hour after ethanol administration, all rats were sacrificed and their stomachs were removed under ketamin anaesthesia. Gastric protection was evaluated by measuring the ulcer index, MDA concentrations, and histopathological studies. Results and discussion: Rats pretreated either with famotidine or CoQ(10) had significantly diminished gastric mucosal damage which was assessed with gross and microscopic analysis (p < 0.00625). MDA levels were significantly lower in famotidine 20 mg/kg and CoQ(10), pretreatment for 7 days group (p < 0.00625). Conclusion: CoQ(10) affords gastroprotection against ethanol-induced gastric mucosal lesions in rats especially after repetitive administrations (Tab. 3, Fig. 2, Ref. 35). Text in PDF www.elis.sk.