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Most studies of sarcopenia in renal transplant recipients (RTRs) have been hampered by a lack of standardization in the definitions of sarcopenia. In this study, we aimed to investigate the prevalence of sarcopenia and the associated factors in RTRs using the recently proposed criteria of the European Working Group on Sarcopenia in Older People 2018 (EWGSOP2), which included a standardized definition of sarcopenia. We examined 93 consecutive adult RTRs, 46 chronic kidney disease patients, and 46 healthy controls. We assessed the muscle strength with a hand grip test using a dynamometer and with a chair stand test. We used bioimpedance analysis to estimate appendicular skeletal mass using the Sergi formula. Finally, we conducted a 2-minute walking test to assess endurance. Sarcopenia and probable sarcopenia were determined according to the revised criteria of the EWGSOP2. Probable sarcopenia was found in 29 RTR patients (31.2%), of them 14 (15.1%) were diagnosed with sarcopenia. Multivariate logistic regression analysis showed that presence of diabetes mellitus, increased uric acid level, and statin use were risk factors for probable sarcopenia. On the other hand, longer dialysis vintage was a risk factor for sarcopenia in RTRs. We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young RTRs. We recommend active screening for the presence of sarcopenia in RTRs, especially in the cadaveric ones. Furthermore, caution seems warranted regarding the myopathic side effects in RTRs who use statins.

Objectives: Biliary cysts are biliary duct dilatations, with 20% of the cysts being diagnosed in adulthood. Abdominal pain, jaundice and palpable abdominal mass are defined as the classical triad. However, nausea, vomiting, fever, itching and weight loss are frequent complaints. There are several treatment options depending on the type of the cyst. This study aimed to share our experience with biliary cysts and contribute to the literature on this subject., Material and Methods: Thirty patients, who received treatment for biliary cyst from January 1981 to December 2018 at our clinic, were studied retrospectively. The patients were analyzed based on age, sex, type of the cyst, diagnosis and treatment methods, post-op follow up and complications., Results: Twenty-seven of the patients were females, and three were males. The patients were aged between 16 and 76 years, and the median age was 41.9 years. All patients presented with abdominal pain, which was accompanied by cholangitis in nine patients, nausea and vomiting in four patients, dyspepsia in three patients and palpable mass in one patient. According to the Todani classification, biliary cyst findings were consistent with Type I in 23 patients, Type V in three patients, Type IV in two patients, Type II in one patient and Type III in one patient., Conclusion: Diagnosis and treatment are complex in biliary cysts due to anatomical proximity and variations. Therefore, it would be beneficial to refer them to referral centers. Choice of treatment should be based on the type of the cyst., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2023, Turkish Surgical Society.)

Objectives: The management of asymptomatic cholelithiasis is controversial. Silent gallstones are generally assumed to cause complications after at least one episode of biliary colic. The ratio of those silent stones that had initially caused, -or were diagnosed as the etiological agent of- acute pancreatitis has not been reported in the literature yet. Our study was designed to investigate the ratio of asymptomatic cholelithiasis in acute biliary pancreatitis cases., Material and Methods: One hundred and seventy-one patients of 305 cases, who were followed up with the diagnosis of acute biliary pancreatitis, were identified retrospectively. Demographic specifications, laboratory findings and clinical progressions of the patients were inspected. Clinical histories were detailed by phone calls. Gallstones were radiologically detected in 85 out of 171 cases. Those patients were divided as symptomatic and asymptomatic. Clinical findings and follow-ups were evaluated by "Chi-square" test., Results: In the study group, 80% of the patients were asymptomatic (n= 68) and 16.47% of the patients (n= 14) had complicated pancreatitis. Regarding the severity of the clinical course, being symptomatic or not was not identified as a significant factor (p= 0.108). In regard of creating symptoms, the size of the stone was not significant (p= 0.561) and obtained no prediction about the clinical severity of the pancreatitis (p= 0.728)., Conclusion: Asymptomatic cholelithiasis patients had a major percentage in acute biliary pancreatitis cases. The "wait and see" approach should be re-evaluated for silent gallstones in prospective trials., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2023, Turkish Surgical Society.)

Introduction: Intra-abdominal and pelvic seeding of hepatic cystic echinococcosis to various organs is a known feature of the disease. Dissemination into distal extremities is uncommon and in this report, we present a case of disseminated cystic echinococcosis extending toward the right popliteal fossa., Case Presentation: A 68-year-old male presented with swelling in the right upper leg and discomfort in the right popliteal region. Work-up revealed various cystic mass lesions of different sizes within the liver, intra-abdominal cavity, right inguinal region, right femoral region, and right popliteal fossa. Diagnosis of hepatic cystic echinococcosis was made and the patient was started on medical therapy., Discussion: Hepatic cysts can be easily observed with ultrasonography and the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) classification system is commonly used to further classify cysts. The work-up of the disseminated disease involves further radiological modalities such as computerized tomography and magnetic resonance imaging. Management includes medical therapy, percutaneous drainage, or surgery depending on hepatic cyst localization and the presence of dissemination., Conclusion: Extrahepatic dissemination of cystic echinococcosis is commonly encountered in endemic areas. Rarely, hepatic cysts can spread beyond the abdomen towards the distal extremities. Therefore, cystic echinococcosis should be included in the differential diagnosis in endemic areas where patients present with cystic masses., (© 2023. The Author(s) under exclusive licence to Witold Stefański Institute of Parasitology, Polish Academy of Sciences.)

Background: Compared with the general population, the risk of death is substantially higher in renal transplant recipients than in age- and sex-matched individuals in the general population. In the general population, coronary artery calcification (CAC) predicts all-cause and cardiovascular mortality. In this study we aimed to analyse these relationships in renal transplant recipients., Methods: We examined 178 renal transplant patients in this prospective observational cohort study. We measured CAC with multidetector spiral computed tomography using the Agatston score at multiple time points. Overall, 411 scans were performed in 178 patients over an average 12.8 years follow-up. The clinical endpoint was a composite including all-cause death and non-fatal cardiovascular events. Data analysis was performed by the joint model., Results: During a follow-up of 12.8 ± 2.4 years, coronary calcification progressed over time (P < 0.001) and the clinical endpoint occurred in 54 patients. In the analysis by the joint model, both the baseline CAC score and the CAC score progression were strongly associated with the incidence rate of the composite event [hazard ratio 1.261 (95% confidence interval 1.119-1.420), P = 0.0001]., Conclusions: CAC at baseline and coronary calcification progression robustly predict the risk of death and cardiovascular events in renal transplant recipients. These findings support the hypothesis that the link between the calcifying arteriopathy of renal transplant patients and clinical end points in these patients is causal in nature., (© The Author(s) 2021. Published by Oxford University Press on behalf of ERA.)

Objectives: Taurolidine is a bicyclic molecule produced by the natural amino acid taurine. Antibacterial, antiendotoxic and cytoprotective effects of taurolidine have been shown experimentally. Data on the effects of taurolidine on oxidative stress and hepatic regeneration are limited. The aim of the study was to evaluate the effect of taurolidine on hepatic regeneration and oxidative stress in rats undergoing partial hepatectomy., Material and Methods: Forty adult, male Wistar Albino rats were randomly divided into four equal groups: sham (S) group (n= 10), post-sham opera- tion taurolidine administered (ST) group (n= 10), partial hepatectomy (H) group (n= 10) and post-partial hepatectomy taurolidine administered (HT) group (n= 10). 100 mg/kg/day taurolidine was administered for seven days. Blood and liver tissue samples were collected on postoperative day seven. Liver tissue malondialdehyde, glutathione and Cu-Zn superoxide dismutase activity (SOD) were measured to assess oxidative stress. Binuclear hepato- cyte and Ki-67 antigen levels were measured to evaluate hepatic regeneration., Results: There was no difference between the groups for malondialdehyde, Cu-Zn superoxide dismutase and glutathione levels (p> 0.05). Binuclear nuclei levels were comparable between the H and HT groups (p= 0.06), while taurolidine decreased binuclear hepatocyte levels in the sham operated groups (p= 0.02). Taurolidine application decreased Ki-67 levels after partial hepatectomy (p= 0.001)., Conclusion: Taurolidine may cause anti-regenerative effects after partial hepatectomy without causing oxidative damage., Competing Interests: Conflict of Interest: The authors declare that they have no conflict of interest., (Copyright © 2021, Turkish Surgical Society.)

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, İstanbul Uni- versity Cerrahpaşa 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., Competing Interests: The authors declare that there is no conflict of interest. No funding has been received for this paper., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objectives: In an attempt to control the new coronavirus pandemic, many countries have taken unprecedented measures, such as extensive social distancing and total lockdowns of cities. Kidney transplant recipients have an increased risk for infectious diseases, including viral infections. In this study, we aimed to investigate the effects of population-wide infection control measures on the mood statuses of kidney transplant recipients., Materials and Methods: We used an electronic survey tool to collect demographic and sociocultural data. Additionally, in the same survey, we used 2 questionnaires (the Profile of Mood States and the Hospital Anxiety and Depression Scale) to measure mood statuses of kidney transplant recipients. We also examined a control group and selected eligible participants according to age- and sex-based propensity score matching., Results: We analyzed the data of 308 participants: 154 kidney transplant recipients (mean age of 39.9 ± 10.6 years; 57.1% male) and 154 control participants (mean age of 39.1 ± 10.5; 57.1% male). With regard to the Profile of Mood States questionnaire, total scores and all subscale scores, excluding vigor, were significantly lower in kidney transplant recipients than in the control group, a finding consistent with a better mood status. We found similar findings in anxiety and depression scores for the Hospital Anxiety and Depression Scale questionnaire., Conclusions: Kidney transplant recipients seem to be resilient to the psychological stress induced by social distancing and lockdown periods. Strict adherence to infection control measures is purposefully suggested in this infection-prone population.

Objective: During the microscopic examination of the specimens after appendectomy operations performed due to acute appendicitis, pathologists may encounter some incidental and unusual lesions. Appendectomy specimens are sampled as 3 sections/1 paraffin block in many centers. In this study, we aimed to evaluate whether multiple and dense sampling of appendix specimens has an impact on the incidence of incidental lesions of the appendix., Methods: This study is a retrospective study of 1154 patients who underwent appendectomy with presumed acute appendicitis at the Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, had histopathological evaluation between 2007-2011 and 2014-2018. Group 1 was made up of the patients whose appendix specimens were examined as 3 sections/1 paraffin block. Group 2 was made up of the patients whose appendix specimens were sampled completely. In this study, it was evaluated whether there was a difference between the two groups concerning incidence of incidental benign and malign appendix lesions., Results: There were 579 patients in Group 1, 575 patients in Group 2, and the mean age of the groups was 26 and 28, respectively. Neither acute appendicitis findings nor any of the other unusual lesions were found in 57 specimens (9.8%) in Group 1 and 58 specimens (10.1%) in Group 2. Unusual pathological findings were detected in six specimens in Group 1 and 21 in Group 2. All unusual lesions, including benign and malignant, were significantly higher in Group 2 than in Group 1 (p=0.013). Concerning the incidence of malignant incidental lesions alone, there was no significant difference between the two groups (p=0.136)., Conclusion: Multiple and dense sampling of appendectomy specimens increases the likelihood of detecting unusual lesions of the appendix., Competing Interests: Conflict of Interest: The authors declared that there is no conflict of interest in this study., (Copyright: © 2021 by Istanbul Northern Anatolian Association of Public Hospitals.)

Background: Is the present study aims to analyze demographic, clinical and surgical data of all patients with FG (Fournier's gangrene) admitted to a tertiary healthcare hospital in the largest city of Turkey., Methods: This study included 35 patients with Fournier's gangrene, who were followed by the General Surgery, Plastic Surgery, and Urology Departments of Istanbul University Cerrahpaşa Faculty of Medicine from January 2010 to January 2015. Demographic and clinical data, including gender, age, length of stay at the hospital, the underlying cause(s), number of debridement, predisposing factors, and surgical reconstructive data over 10 years were assessed and analyzed retrospectively., Results: The mean age of the 35 patients was 58.14±12.71 years. Diabetes mellitus was present in 20 of the 35 (57.1%) patients. Twelve of the patients (34.2%) were hospitalized in the intensive care unit (ICU). Length of stay in the ICU was found to be significantly influenced by age, hematocrit level, FGSI and UFGSI (p=0.013, p=0.030 p=0.025 and p=0.002, respectively)., Conclusion: Fournier's gangrene is a fulminant infection with a high mortality rate. Physical examination and anamnesis are quite important for the diagnosis of FG. DM is the most common comorbidity. Age, hematocrit level, FGSI and UFGSI scores affect the patients' length of stay in the ICU.

Background: The determination of a definitive preoperative diagnosis of acute appendicitis (AA) remains a challenge; however, delays in diagnosis increase complication rates. The aim of this study was to investigate the contribution of the Alvarado score (AS) alone and the AS combined with the use of the biological indicators of C-reactive protein (CRP), procalcitonin (PCT) and neopterin (NP) in the diagnosis., Methods: Serum was collected from 100 patients who were admitted to the general surgery clinic of Istanbul University, Cerrahpasa Medical Faculty between March 4, 2014 and July 29, 2015 with the pre-diagnosis of AA and who agreed to take part in the study. The serum samples were stored at -70°C. The patients were divided into 2 groups: AA-positive (n=60) and AA-negative (n=40). The AA positive group was divided into subgroups of complicated (n=11), uncomplicated AA (n=49) and the AS, CRP, PCT, NP levels were compared., Results: The study population consisted of 45 men (45%) and 55 women (55%), with a mean age of 32.8+-13.7 years (range: 18-92 years). There was no significant difference between the groups in age and gender. There were 24 patients with an AS ≤4 (3 had surgery), 35 patients with an AS of 5-7 (22 had surgery), and 41 patients with an AS of 8-10 (38 had surgery). Three of the 63 patients who underwent surgery were diagnosed with a normal appendix. The serum CRP, PCT, and NP measures were found to be inadequate to make an AA diagnosis alone, these values increased the sensitivity and specificity of the AS. The biological indicators were also significant in differentiating between the complicated and uncomplicated AA groups (p<0.05)., Conclusion: Although the AS is useful, additional testing and clinical approaches are valuable to inform the diagnostic procedure. When considered alone, serum CRP, PCT and NP values are insufficient for a diagnosis of AA. However, they increased the diagnostic value of the AS and can be helpful in distinguishing complicated AA cases.

Here, we report the case of an 84-year-old woman with acute mechanical intestinal obstruction (AMIO) who was admitted to our Emergency Department. Computed tomography (CT) scan revealed an incarcerated bilateral obturator hernia, and the defect was resolved using transabdominal preperitoneal (TAPP) technique with polypropylene mesh. The patient was administered an oral regimen two days after the operation. The patient stayed in the intensive care unit for 4 days and was uneventfully discharged on the 9th postoperative day. Follow-up was scheduled at the 6th month, during which no adverse events were detected and the patient did not report any complaints. Obturator hernia is among the differential diagnoses of intestinal obstruction requiring early diagnosis and prompt surgical intervention. Laparoscopic approach is less invasive compared with open surgery, and it can be attempted in cases presenting with no sign of ischemia or peritonitis. TAPP technique should be preferred since it allows the control of all intraabdominal pathologies and the viability of the intestines.

Background: The goal of this study was to present our experience in the management of endoscopic retrograde cholangiopancreatography-related complications in patients referred to our surgical emergency unit by various endoscopy centers., Methods: A retrospective investigation was conducted on the records of the 54 patients who were referred to our surgical emergency unit between October 2005 and January 2014 due to endoscopic retrograde cholangiopancreatography-related complications., Results: There were 25 and 29 female and male patients, respectively. Pancreatitis was the most common complication (38.8%). Perforation (27.7%), infection (20.3%), and bleeding (12.9%) were the other complications. In 22.2% of cases, patients were died. The mortality rate was the highest in patients with perforation (40%). The mean age of the patients who were died due to complications was 75.9 years (range, 47-94 years). In total, 41.6% of the patients were died within the first week and 33.3% were died within the second week following ERCP. Nearly half of these patients had a cancerous disease (one had metastatic breast cancer, one had a gallbladder cancer, one had a duodenal cancer, and the other three had periampullary cancers) and 50% of the patients who died also had cardiopulmonary and/or cerebrovascular disorders., Conclusion: Comprehending and managing the main risk factors can minimize complications; however, they would not be eliminated. Moderate and severe complications may increase the mortality rates, particularly in high-risk patients.

Aim: Notwithstanding the significant advantages compared to open surgery, laparoscopic surgery was considered to be contraindicated in pregnant patients. Currently, there are opposing views on the safety of laparoscopic surgery during pregnancy, especially in last trimester. The aim of this study was to examine feasibility of laparoscopic surgery in pregnant women with acute abdomen., Patients and Methods: We retrospectively reviewed records of all patients who were admitted to the Emergency Department of Cerrahpasa Medical Faculty between January 1995 and January 2013. All clinical data of pregnant patient who underwent laparoscopic surgery were analyzed including inpatient records, operative reports, pathology records, and delivery information., Results: Fourteen pregnant patients (mean gestational age 19.2 weeks, ranged from 9 to 33 weeks) who underwent laparoscopy for appendectomy (n=11), cholecystectomy (n=2), and diagnostic reasons (n=1) were included. Average time of delivery was 37.4 gestational weeks (range 35-40 weeks). Two patients had preterm labor. No complications such as uterine injury, fetal death, or maternal mortality were encountered during laparoscopic procedures, Conclusion: Laparoscopic surgery can be safely performed at all trimesters of pregnancy. Laparoscopy may be useful in differentiation of acute abdominal pain in pregnancy and may decrease fetal loss due to delay in diagnosis. shorter operative time reduces negative effects of surgery on mother and fetus.

Background: The present study was carried out to investigate oxidant-antioxidant status and serum total sialic acid (SA) levels as alternative markers complementary to routine laboratory tests in an experimental obstructive jaundice model (OJM). Rats were divided into three groups: sham operated control (SOC), OJM monitored for 7 days (OJM-7), and OJM monitored for 14 days (OJM-14). Antioxidant activities, lipid peroxidation, C reactive protein (CRP), and SA concentrations were analyzed at the end of post-operative days 7 and 14. In both OJM groups, SA and CRP levels were significantly increased when compared with the SOC group. Moreover SA and CRP levels were significantly correlated in both groups. As a marker of inflammation and oxidative stress in obstructive jaundice, serum SA may serve as an adjunct when combined with other markers in disease screening and progression.

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.

Candidal infections occur commonly in renal transplant recipients especially in genitourinary system. Although the epidemiology of candiduria has not been well characterized in renal transplant population, it is the most common cause of fungal infections. However, candidal psoas abscess is very rare in the literature. We report a 42-year-old male renal transplant recipient with prolonged pyuria and candiduria followed by candidal psoas abscess formation. The treatment consisted of prolonged antifungal therapy along with percutaneous drainage. However, eventually, a surgical drainage had to be performed for the successful eradication.

A standard hepaticojejunostomy technique might be difficult to perform, especially when the bile duct is small and located deep in the liver hilum. Herein we present a new procedure, the Hand-Fan technique, that was used to enhance the exposure and ease the performance of these challenging anastomoses. Thirty-one patients who had had hepaticojejunostomy with this technique for bile duct injury and other benign biliary pathologies from July 2004 to June 2011 were included into the study. Median postoperative hospital stay was 7 days (6-25 days) and median follow-up time was 33 months (2-84 months). Liver function tests revealed that the blood bilirubin levels of the patients were normalized after hepaticojejunostomy. Follow-up showed that there were no signs of clinical recurrence or impaired bile flow. The Hand-Fan technique considerably facilitates challenging hepaticojejunostomies. Surgeon's comfort is exceptional and the clinical results are satisfactory.

Background: Cardiovascular disease is the leading cause of mortality among renal transplant recipients. In the general population, coronary artery calcification (CAC) and progression of CAC are predictors of future cardiac risk. We conducted a study to determine the progression of CAC in renal transplant recipients; we also examined the factors associated with progression and the impact of the analytic methods used to determine CAC progression., Methods: We used multi-detector computed tomography to examine CAC in 150 prevalent renal transplant recipients, who did not have a documented cardiovascular disease. A baseline and a follow-up scan were performed and changes in CAC scores were evaluated in each patient individually, to calculate the incidence of CAC progression. Multivariate logistic regression analysis was used to evaluate the determinants of CAC progression., Results: Baseline CAC prevalence was 35.3% and the mean CAC score was 60.0 ± 174.8. At follow-up scan that was performed after an average of 2.8 ± 0.4 years, CAC prevalence increased to 64.6% and the mean CAC score to 94.9 ± 245.7. Progression of individual CAC score was found between 28.0 and 38.0%, depending on the method used to define progression. In patients with baseline CAC, median annualized rate of CAC progression was 11.1. Baseline CAC, high triglyceride and bisphosphonate use were the independent determinants of CAC progression., Conclusions: Renal transplantation does not stop or reverse CAC. Progression of CAC is the usual evolution pattern of CAC in renal transplant recipients. Beside baseline CAC, high triglyceride level and bisphosphonate use were associated with progression of CAC.

Background/objective: Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite treatment on oxidative stress after partial hepatectomy. In this experimental study, the effects of clinoptilolite treatment after partial hepatectomy on oxidative stress were evaluated., Methods: There were four experimental groups (n=8): Group S, the sham group; Group H, the hepatectomy group; Group HC, the clinoptilolite treatment after partial hepatectomy group; and Group CS, the clinoptilolite-treated sham group. A 70% partial hepatectomy was performed for Group H and HC. Clinoptilolite (5mg/kg) was given to the rats orally (via gavage tube) twice a day for 10 days after hepatectomy. Malondialdehyde (MDA), Cu-Zn super oxide dismutase (SOD), and glutathione (GSH) levels were assessed to evaluate oxidative stress., Results: Plasma and liver tissue MDA levels of Group HC were significantly lower than the H group (p=0.018 and p=0.000, respectively). Liver tissue Cu-Zn SOD activity and GSH levels of Group HC were significantly higher than Group H (p=0.003, p=0.007, respectively)., Conclusion: Clinoptilolite administration reduces oxidant activity and supports antioxidant response after partial hepatectomy., (Copyright © 2011. Published by Elsevier B.V.)

Background: Few studies have been published on liver resection alone or in combination with cytoreductive surgery for liver metastases of ovarian carcinoma., Methods: Eight patients who underwent liver resection for metastasis of ovarian cancer were included in the study. Total abdominal hysterectomy and bilateral salpingo-oophorectomy had been performed before liver surgery in all patients. The demographic data, follow-up details before and after liver resection, histopathology of the primary ovarian cancer, type of surgery and outcome were evaluated., Results: The mean age of the patients was 56.1 (46-68) years. The mean hospitalization time was 8 (7-10) days. The mean disease-free interval was 5.38 years from the time of initial surgery to surgery for metastatic liver lesions, and 39 months after liver resection to secondary metastases. Four patients did not have any evidence of disease after liver surgery., Conclusion: Indications for liver resection should be considered in selected patients who have a limited extent of metastatic disease from ovarian carcinoma. Liver resection for metastases of ovarian carcinoma could be an effective and feasible approach., (Copyright © 2010 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.)

Background: Spontaneous intramural hematoma of the small intestine is a rare clinical condition that may result in potentially serious complications. The purpose of this study was to present our experience with the diagnosis and management of spontaneous intramural hematoma of the small intestine., Methods: The medical records of the patients with spontaneous intramural hematoma of the small intestine were retrospectively reviewed. Six patients were included in this study., Results: Anticoagulation therapy and factor VIII deficiency were found to be responsible for the intramural hemorrhage in five patients (83%) and one patient, respectively. Acute abdominal pain followed by nausea and vomiting were the most common presenting symptoms. Abdominal computed tomography scan was diagnostic in five of the six patients. Four patients were followed up with conservative therapy. Surgical intervention was required in two patients due to acute abdomen. All patients were discharged from the hospital uneventfully., Conclusion: The patient's medical history, physical examination and radiological evaluation proved adequate for the diagnosis. Conservative therapy provides regression of the hematoma in most patients. Surgery should be reserved only for the complicated cases.

Background: Various techniques have been used for the division of mesoappendix, such as endoloops, endoscopic linear cutting staplers, an electrothermal vessel-sealing system (LigaSure), the Harmonic Scalpel, clips, and bipolar coagulation. In the present study, LigaSure and an endoclip were compared in laparoscopic appendectomy (LA)., Materials and Methods: This study included patients who underwent LA for acute appendicitis at Istanbul University, Cerrahpasa Medical Faculty, Emergency Unit (Istanbul, Turkey) between May 2003 and April 2007. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and endoclip groups. The main outcome measures (e.g., operating time, conversion rate, hospital stay, postoperative complications, etc.) were then compared., Results: LA was performed in 280 patients with acute appendicitis. LigaSure and endoclips were used in 127 and 153 patients, respectively. The mean operative times were 41 and 54 minutes in the LigaSure and endoclip groups, respectively. Conversions to open rates were found to be 9.4% (12 patients) in the LigaSure and 11.1% (17 patients) in endoclip groups. No statistically significant differences regarding hospital stay or complications were found, whereas significant differences were observed in surgical time and conversion rate., Conclusion: The use of LigaSure facilitates the dissection of mesoappendix and shortens the operation time in LA. We believe that LigaSure is a safe, useful tool for mesoappendix dissection.

Background: Laparoscopic adhesiolysis became popular in the last decade for the management of postoperative adhesive small bowel obstruction. This paper investigates the feasibility, effectiveness and safety of laparoscopy in this field; the details of a selective adhesiolysis were discussed as well., Methods: The patients who underwent laparoscopic management of acute or chronic recurrent adhesive bowel obstruction were included into the study. The patients were managed according to a specific algorithm. If the conservative management has failed, selective laparoscopic adhesiolysis to the transition zone of distended /collapsed bowel was performed. Patients, who were suffering from chronic recurrent obstruction attacks and those who tolerated oral intake, underwent preoperative enteroclysis studies and selective adhesiolysis was performed according to imaging findings. Computerized tomography was performed in all cases to exclude other diagnoses., Results: Thirty-one patients (22 female, 9 male) underwent laparoscopic adhesiolysis from January 1998 to June 2007. The mean age was 48 (range: 20-80). Enteroclysis--guided laparoscopic adhesiolysis was performed in nineteen patients. Twelve patients underwent laparoscopic adhesiolysis for acute obstruction. Enteroclysis was able to demonstrate the pathological adhesion or band in all of the patents who underwent this imaging technique. Conversion and complication rates were 9.6%. The entire patients tolerated well oral intake postoperatively except one who had underwent enteroclysis-guided adhesiolysis; the patient presented with transient subileus on postoperative day 34 and responded well to conservative management. Mean hospital stay was 4.1 days (range: 2-7). The patients are free of symptoms on their follow-up., Conclusion: Laparoscopy is feasible, safe and effective in postoperative adhesive disease. Laparoscopic adhesiolysis should be performed as selective as possible in acute and chronic cases. Enteroclysis is a helpful imaging modality for performing selective laparoscopic adhesiolysis in chronic obstruction.

Background: Occult diaphragmatic injuries are associated with significant mortality, if the diagnosis is delayed. We report our experience in diagnostic and therapeutic thoracoscopy in a selected group of patients with stab wounds of thoracoabdominal region., Methods: The patients who underwent thoracoscopic management of thoracoabdominal stab injuries between June 2001-December 2005 were included into the study. The data were retrospectively analyzed., Results: Ninety-three patients with abdominal and thoracoabdominal stab wounds underwent videoendoscopic management. Among them, eleven selected patients with thoracoabdominal stab injuries were managed by thoracoscopy. The procedures were performed under general (n=10) or local anesthesia (n=1). Diaphragmatic injuries were repaired by intracorporeal sutures in three cases and bleeding was controlled in another two cases by electrocautery coagulation. The procedures were simply diagnostic in six patients. The mean operating time and hospital stay were 35 minutes and 3.5 days respectively. There was neither intraoperative or early postoperative complication, nor mortality., Conclusion: Thoracoscopy is a safe and efficient tool in the diagnosis and treatment of diaphragmatic stab injuries.

Purpose: To investigate the effect of mesh fixation devices on the formation of intra-abdominal adhesions., Materials and Methods: Fourteen New Zealand rabbits were used. In seven animals, nickel-titanium (nitinol) anchors (group 1) and titanium tacks (group 2) were applied by laparoscopy on the right and left sides of the abdomen, respectively. In the remaining seven rabbits, the same devices were applied on prosthetic meshes (groups 3 and 4, respectively). On day 30, the rabbits were sacrificed and macroscopic adhesion scoring was performed. All the specimens were assessed by scanning electron microscopy (SEM)., Results: All parameters of adhesion except extension were significantly higher in group 4 than group 3 (P < 0.05). Comparisons of group 1 vs. group 2 were not statistically significant (P > 0.05). All the comparisons between a nonmesh group and a mesh group resulted in significant differences. SEM results revealed that the mesothelial cell layer and connective tissue intensively covered the tacks in group 2 whereas no similar findings were observed in group 1. Comparable appearances were encountered in groups 3 and 4., Conclusion: The nitinol anchor is associated with an acceptable level of adhesion formation and its intraperitoneal use can be considered safe in this regard.

Hypothesis: In this study, we aimed to investigate whether the use of a sodium hyaluronate and carboxy-methylcellulose-based antiadhesive membrane (Seprafilm, Adhesion Barrier; Genzyme Corp, Cambridge, Mass) is associated with fewer adhesions around the pelvis and rectal pouch., Design, Interventions, and Main Outcome Measures: Forty Wistar albino female rats were divided into 4 equal groups. Each rat underwent segmental left-sided colonic resection and end colostomy. The groups were as follows: group 1, colostomy alone (control group); group 2, colostomy and Seprafilm application around distal rectal pouch; group 3, colostomy and Seprafilm application beneath laparotomy incision; and group 4, colostomy and application of Seprafilm on both rectal pouch and laparotomy incision. All animals were operated on the 21st day and intra-abdominal adhesions were evaluated., Results: The results were assessed by analysis of variance and Tukey multiple comparison tests. Intra-abdominal adhesions were significantly (P<.05) reduced in groups 2 through 4 compared with the control group, whereas no statistically significant difference was observed between these 3 groups., Conclusions: The use of Seprafilm during the initial step of the Hartmann colostomy reduced intra-abdominal adhesions on the reversal. This result might be beneficial in the prevention of adhesion-related difficulties during second operation and its application beneath laparotomy incision seems to be sufficient to ensure this effect.

Background: To assess the effects of halofuginone, a specific inhibitor of synthesis of collagen type 1, which is the major constituent of fibrosis, on esophageal stricture formation due to caustic ingestion., Methods: Sixty rats were divided into four equal groups: control group; sham laparotomy group; caustic injury without treatment group; caustic injury with halofuginone treatment group. Caustic injuries were done by 50% sodium hydroxide. Halofuginone was administered by the first postoperative day. All animals were sacrificed on day 21; and the results were evaluated by hydroxyproline levels, stenosis index, lumen diameter, histopathological evaluation, wall thickness, and animal weights., Results: Mortality differences were significant comparing group 3 with group 1 and 2 (P = 0.006) and group 4 (P = 0.03). According to hydroxyproline levels, the differences are significantly higher (P <0.001) comparing group 3 with group 1, 2, and 4. The P value was considered significant in all other parameters (P <0.001) for all the groups but group 1 versus group 2 (P >0.05)., Conclusions: Halofuginone, a specific inhibitor of collagen type 1 synthesis, significantly reduced esophageal stricture occurrence.

In this study, we investigated clinical features, aetiology, prospective follow-up results and also factors favouring secondary erythema nodosum (EN) in patients with EN. A total of 50 patients (mean age 38 y) with a diagnosis of EN between 1993 and 2002 in our clinic were included in the study prospectively. A biopsy was performed in 30 of the patients. Patients were considered to have secondary EN when an underlying condition was found, and to have primary (or idiopathic) EN when no such condition was found. For the diagnosis of the underlying diseases, diagnostic criteria and/or diagnostic methods were used. Categorical variables were compared by using chi2 test. The majority of the patients were female (6F/1M) and 54% of cases had a determined aetiology. The foremost aetiology was primary tuberculosis (18%) followed in decreasing order by a poststreptococcal (16%), sarcoidosis (12%), inflammatory bowel diseases (IBD) (4%), Behçet's disease (2%), and pregnancy (2%). All the patients were followed for a mean duration of 7 y. The nodosities relapsed every y in 74% of idiopathic EN patients but in only 1 (Behçet's disease) of the secondary ones. Factors favouring secondary EN were as follows: prolonged fever, cough, sore throat, not relapsing EN, abnormal chest X-ray, leukocytosis, an erythrocyte sedimentation rate of higher than 50 mm/h and a CRP value of higher than 6 times the upper limit of normal. All the patients had bed rest and the majority was given naproxen. The outcomes were usually favourable within 7 d. The patients with an underlying disease were given specific treatment. EN has been associated with numerous diseases. In order to reduce cost and duration of diagnosis, every centre should determine its own most frequent aetiological factors. Factors favouring secondary EN should also be determined. Our study revealed primary tuberculosis, streptococcal pharyngitis, sarcoidosis, IBD, and Behçet's syndrome as the main aetiologies of EN.