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Objective: To compare primary repair and grafting with one of two materials (one biological human dura mater, and one synthetic polypropylene mesh) or autologous skin, with primary repair alone in abdominal wall hernias in rats. Design: Randomised experiment. Setting: Teaching hospital, Turkey. Animals: 72 male Wistar albino rats randomised into 4 groups of 18 rats each. These were further randomly divided into subgroups of 6 each that were killed on days 15, 30, and 45 postoperatively. Interventions: Each test material was sutured to the abdominal wall by an onlay technique. Main outcome measures: Macroscopic and microscopic appearance, and strength of the abdominal wall. Results: Macroscopically, dura mater grafts lost their original shape, but polypropylene and skin did not. When completely incorporated the skin grafts had developed a new fascia. Dura mater and polypropylene induced a pronounced inflammatory reaction at all three times postoperatively, and there were significantly more fibroblasts in the dura mater group on days 15 and 30, and in the skin graft group on day 45, than in the other groups (p < 0.05). Mechanical resistance and mean breaking strength were significantly greater in the skin graft group than in the other groups at all times tested (p < 0.05). Conclusion: Full thickness autologous skin grafts were stronger than both human dura mater and polypropylene mesh when used to reinforce primary repairs of abdominal wall hernias in rats. [ABSTRACT FROM AUTHOR]

Objective: To find out if 5-fluorouracil (5-FU) given intraperitoneally to rabbits impaired the healing of colonic anastomoses, and whether giving zinc might reverse the effect. Design: Laboratory study. Setting: Teaching hospital, Turkey. Animals: 32 New Zealand white rabbits. Interventions: All animals had 1cm of large bowel resected 10cm proximal to the peritoneal reflection and continuity restored by end-to-end anastomosis. They were divided into four groups and given intraperitoneal injections of saline (control group), 5-FU 10mg/kg/day in a concentration of 5mg/ml saline (5-FU alone group), zinc 2mg/kg/day (zinc alone group), and the same doses of 5-FU and zinc (5-FU + zinc group). The injections were given immediately after operation and daily for 4 days. The rabbits were killed at 7 days. Main outcome measures: Bursting pressures, tissue hydroxyproline concentrations, tissue zinc concentrations, and light and electron microscopic appearances. Results: Six rabbits died of the complications of anaesthesia and 4 of sepsis leaving 7, 6, 7, and 6 rats in the four groups respectively. Mean (SD) anastomotic bursting pressures were significantly reduced in the 5-FU group compared with controls (5 (2) compared with 7 (1) mm Hg, p: 0.05) and collagen synthesis (indicated by reduced tissue hydroxyproline concentrations) was also decreased (7.1 (0.9) compared with 9.1 (1.5), p < 0.05). Rabbits given 5-FU + zinc had significantly higher bursting pressures than those given 5-FU alone (9 (2) compared with 5 (2), p: 0.01). Bursting pressures were also significantly higher in those given zinc alone, but hydroxyproline concentrations were similar to those in the control group. Histological examination showed that 5-FU alone significantly impaired the healing process, and those in the 5-FU + zinc group healed better than those in the 5-FU alone group. Conclusions: 5-FU given intraperitoneally significantly impaired the healing of colonic anastomoses in rabbits, and zinc reversed this effect. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy on the incidence of hypocalcaemia after thyroidectomy. :Design: Prospective non-randomised study. :Setting: Teaching hospital, Turkey. :Subjects: 216 patients who had bilateral subtotal thyroidectomy for non-toxic nodular goitre between 1990 and 1996. :Interventions: The trunk of the each inferior thyroid artery was simply ligated during bilateral subtotal thyroidectomy. :Main outcome measures: Clinical examination, and measurement of serum calcium, ionised calcium, and inorganic phosphate concentrations before and after operation. :Results: Four patients (2%) had low concentrations of total and ionised calcium during the postoperative period. On physical examination three of them had spasms of the facial nerve, as seen in tetany. They were given calcium supplements orally and their laboratory results returned to reference ranges within 180 days. No patients developed permanent hypocalcaemia. :Conclusion: Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy has no effect on the incidence of hypocalcaemia after thyroidectomy. [ABSTRACT FROM AUTHOR]

Endometriosis affects women during the reproductive period and can cause functional disorders. Sometimes general surgical intervention is necessary owing to disease boundary. The sigmoid colon and rectum are particularly affected because of their close relationship. In this case, treatment must be individualized according to the patient and symptoms. If the lesion penetrated the entire bowel wall, bowel resection may be inevitable. Laparoscopic resection of the sigmoid colon or rectum can be performed safely in this situation. When laparoscopic resection is not possible because of technical difficulties, open resection may be performed as a mode of treatment.

Previous abdominal surgery is the most common cause of mechanical small bowel obstruction. However, in patients with no abdominal surgery history, it is difficult to diagnose and treat. Omphalomesenteric duct is a primitive embryonic structure of fetal development between the midgut and yolk sac. In some cases, it may persist and result in several complications, particularly in childhood. In adults, intestinal obstruction due to persistent omphalomesenteric duct is an extremely rare circumstance. We report a 42-year-old male patient presenting with omphalomesenteric duct remnant causing small bowel obstruction.

Background: In this study, scald burns in a Turkish population (0-16 years of age) were studied with reference to their occurrence and common causes., Methods: Of the burn victims hospitalized at the Burns Unit of Ankara Numune Education and Research Hospital between April 2001 and December 2003, 354 patients were aged 3 months to 16 years and 228 (64.4%) were male., Results: When burn causes were examined, scald burns were the primary type, reported in 77.7% (275) of the patients (p < 0.001). Scalds were the most frequent burn agents in the pediatric population. Tea is a traditional beverage in Turkey. It is consumed especially at breakfast and throughout the day until late at night. Tea in Turkey is steeped and brewed for consumption. As brewing and steeping is a time-consuming process and the tea is served hot, the appropriate level of care regarding the hot tea is neglected. Consequently, tea carries a serious potential to cause burns in this country. Of the scalded children, 93 scald burns (33.8%) were due to the tea itself or to the boiling water used in steeping tea, and 87.1% of these children were preschoolers. The mortality rate was 7.1% in the hospitalized children group., Conclusion: Traditional behaviors may sometimes have some serious unexpected consequences. In households where family members tend to ignore an ongoing problem, governmental and non-governmental organizations should consider taking preventive measures to protect the children from the devastating consequences of such negligence.

Background/aims: Scoring systems are generally used for predicting prognosis in critically ill patients, but not frequently for predicting prognosis in cancer. Our aim was to develop a prognostic score for colorectal cancer., Methodology: Demographic, clinical, laboratory, radiologic, histopathologic and operative data of 112 patients who had resection for colorectal cancer, were analyzed for their effect on survival. Eight variables (invasion depth of tumor, nodal status, presence of metastasis, CEA level, differentiation, resectability, tumor location, presence of blood transfusion), which have the most significant effect on survival in univariate analysis and multivariate analysis, were chosen. Coefficients were calculated and the Prognostic Score for Colorectal Cancer (PSCRC) was designed. All patients were scored using this system and staged according to TNM, Dukes and Astler-Coller systems., Results: The score range is between -49 and 80. Patients were grouped as Group 1 (score < -30), Group 2 (score -30 to -6), Group 3 (score -5 to 19), Group 4 (score > 19). Survival rates decreased and recurrence rates increased significantly with increasing scores. The associations of PSCRC and staging systems with survival and recurrence rates were determined by logistic and Cox regression analyses. PSCRC was proved to have the most significant association with survival and recurrence rates. Furthermore, PSCRC had better correlation with survival and recurrence rates when compared with staging systems according to Pearson correlation analysis., Conclusions: Inclusion of more variables in PSCRC seems to make it superior to the staging systems. PSCRC may be a practical and useful scoring system in clinical practice and is easily adapted to different patient populations.

Background/aims: This study was planned to investigate the therapeutic value of performing an extended lymphadenectomy in potentially curable gastric cancer., Methodology: A prospective gastric cancer database was used. In total 114 gastric cancer patients (85 male, 29 female) who underwent a gastrectomy for curative intent from 1992 through 1999 were included to this study. Morbidity and mortality, survival rates and factors affecting survival were evaluated., Results: Sixty-six (58%) patients had limited (D1) and 48 (42%) patients had extended (D2) gastric resections. The operative mortality rates were 12% and 8% and the postoperative complication rates were 33% and 25% in the D1 and D2 lymphadenectomy patients, respectively. The mean follow-up period was 34 (range: 8-94) months. The overall mean survival was 32 months (25 months in D1 group, 46 months in D2 group) (P < 0.05). The duration of symptoms, the presence of postoperative complications, the extent of lymphadenectomy, the operative curability and the site of the tumor were all found to be independent prognostic factors based on a multivariate analysis., Conclusions: This study demonstrates that an extended lymph node dissection improves long-term survival without increasing postoperative morbidity and mortality in patients with potentially curable gastric cancer.