LAPAROSCOPIC NISSEN ROSETTI FUNDOPLICATION IN TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE: EVALUATION OF LONG TERM CLINICAL OUTCOMES AND QUALITY OF LIFE

The aim of this study is to evaluate outcomes of Nissen-Rossetti fundoplication in-terms of objective measures and quality of life evaluation instruments. For the period in observation, the chronic GERD patients, who had undergone LNRF surgery, were evaluated. The long-term outcome was assessed by subjectively comparing the preoperative and postoperative symptoms and Gastroesophageal reflux-Health related quality of life index. As an objective assessment of the pathological reflux, patients underwent 24-hour pH monitoring in the preoperative and postoperative period. Thirty-two patients, who met the criteria and volunteered to participate, were included in the study. The median postoperative follow-up period for the patients was 28±7.92 (16-52) months. A significant increase was observed in the quality of life scores in the postoperative period when compared to the preoperative period (p=0.001) and the DeMeester scores have decreased significantly (p=0.001). The postoperative dysphagia was observed even in the long term in most of the patients, without having a significant effect on the quality of life. In the treatment of gastroesophageal reflux disease, laparoscopic Nissen Rossetti fundoplication is an effective and successful method in achieving the desired outcome such as preventing pathological reflux, relieving the symptoms and improving the quality of life in the long term.

Is a routine preoperative rectosigmoidoscopy necessary in patients with bilateral inguinal hernia?

OBJECTIVES

The purpose of this prospective study was to evaluate the association between bilateral inguinal hernias and colorectal cancers.

PURPOSE

Inguinal hernias are one of the most common subjects in surgical practice and have been known to be associated with some other pathologies since 1831. Although there are some series in literature reporting the association of colorectal cancers with inguinal hernias, it is still controversial to perform colorectal diagnostic tools in hernia patients. Colorectal cancers are particularly accused to be in association with synchronous bilateral hernias as they increase the intra-abdominal pressure.

METHODS

Rectosigmoidoscopy was performed in 110 consecutive bilateral hernia patients and the results were recorded prospectively. Patients having colorectal diseases were excluded.

RESULTS

There were no pathologies in 87 (%79,1) rectosigmoidoscopies, while benign pathologies (hemorrhoids, polyps and diverticulitis) were diagnosed in 23 (%20,9).

CONCLUSIONS

It has not been proved yet that colorectal cancers increase the incidence of bilateral inguinal hernias. The incidence of benign pathologies in our series was similar to that of same age population without hernia. As a conclusion of this study we believe that rectosigmoidoscopy is not necessary for synchronous bilateral hernias unless the patient has any complaints or risk factors. Colorectal screening tools are performed when the clinical findings or the story of the patient support colorectal cancers) (Tab. 1, Ref. 25).

A simple modified technique for repair of umbilical hernia in patients undergo laparoscopic cholecystectomy. Report of 10 cases

BACKGROUND AND AIM

Umbilical hernia frequently accompanies cholelithiasis. It is possible to repair these hernias after completing cholecystectomy. We herein describe a simple modified technique for the repair.

PATIENTS AND METHOD

The technique was applied to 10 patients undergone laparoscopic cholecystectomy. After cholecystectomy has been performed, periumbilical trocar incision is extended toward the umbilicus. The hernia sac is sent into the abdominal cavity and one or two simple sutures are put to approximate the fascial edges of the umbilical hernia. A similar approximation is done for trocar hole. A piece of polypropylene mesh covering both defects with an adequate overlap at four edges is fixed in onlay position.

RESULTS

No wound complications were recorded. After a median of 23 months (6-40 months) follow-up no recurrence was observed.

CONCLUSION

This simple modified repair may especially be useful in centers where the surgeons can easily perform cholecystectomy laparoscopically, but are not familiar with laparoscopic hernia repair and mesh placement or haven't the equipment and material necessary for a laparoscopic repair.

Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients

OBJECTIVE

The study was designed to compare the early postoperative results of the commonly used two surgical flap procedures in pilonidal disease: Karydakis and Limberg.

METHOD

One hundred patients were randomized into two groups and standard Limberg or Karydakis procedures were performed. All had primary sinus orifices. Infected cases and the ones with secondary orifices over 2 cm distant from primary were excluded. Data were recorded concerning complications, need for analgesia and wound dressing, periods of time off work and off driving. Patients were asked to classify their first defecation manner after the operation and also pain according to a Visual Analogue Scale with range of 1-10.

RESULTS

There was a significantly higher wound infection rate in the Karydakis group than in the Limberg group (13/50 and 4/50 respectively). This also resulted in significantly higher values for wound dressings and need for analgesia. The time off work and off driving and also the Visual Analogue Scale scores were not significantly different between the two groups.

CONCLUSION

Both procedures can be safely performed in pilonidal disease with a standard length of stay in hospital and a similar loss of productive power. However, the Karydakis flap seems to have a significant higher infection rate and this probably increases the cost.

Founding the first hernia center in Turkey

For years, centers dedicated to hernia surgery have been operating in North America and Europe. However, such centers have not been available to patients in most other countries, including Turkey. In 2006, the first Turkish center devoted to hernia surgery, the "Ankara Hernia Center", was opened. In this paper, we present general information about the center's construction, staff, practice, patient profiles, and future goals.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia

AIM

To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia.

SUBJECTS AND METHOD

Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded

RESULTS

No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001).

CONCLUSION

Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.

The effects of interferon-beta on interleukin-10 in multiple sclerosis patients

The incidence of the neuropathological lesions and the severity of the clinical symptoms in multiple sclerosis (MS) are correlated with the amount of the transferred autoreactive T cells. The balance between the T helper 1 (Th1) and T helper 2 (Th2) cytokine phenotypes may affect the activity of the disease in MS patients. Interleukin-10 (IL-10) is a cytokine secreted by Th2 cells. Thus, it has been thought that inducing IL-10 may have therapeutic effects in the treatment of MS patients. In this study, in order determine whether different types of prophylaxis change the secretion of IL-10, we measured the levels of IL-10 in relapsing-remitting type multiple sclerosis (RRMS) patients receiving interferon-beta 1b (IFN-beta 1b) or azathioprine (AZA). Our study consisted of RRMS patients (n=45) and healthy subjects (n=15) as control group. Patients were categorized into three groups as those receiving either IFN-beta 1b or AZA and those not receiving prophylaxis. Each group was compared with the control group. Serum IL-10 levels were determined using ELISA method. IL-10 levels of those receiving IFN-beta 1b were found to be significantly higher than that of other groups. These results support that the ability of inducing anti-inflammatory cytokine IL-10 plays a role in the clinical advantage of IFN-beta 1b in MS treatment.

The place of the technique of narrowing neck of the dartos pouch on the ascent of testis after surgery

OBJECTIVE

We aimed to compare the three techniques of dartos pouch orchiopexy, suture fixation to the scrotal wall and narrowing of the neck of pouch with or without suture fixation, in regard to the postoperative ascensus of testes.

MATERIALS AND METHODS

We operated on 150 unilateral palpable undescended testis with the scrotal pouch orchiopexy technique. In this prospective study, patients were randomly divided into three groups: Testes were fixed to the scrotal wall in the first group, they were placed into the scrotal pouch without fixation but the neck of the dartos pouch was narrowed around the vas deferens and the vessels in the second group and testes were fixed to the scrotum with a suture and the dartos fascial opening was narrowed concomitantly in the third group.

RESULTS

Patients were followed between 6 and 48 months (28.0 +/- 11.4). Only four testes of the first group (8.0%) were replaced upward after the operation where all the other two groups' testes were in their places.

CONCLUSION

We believe that only narrowing of the dartos fascia around the vas deferens and vessels without fixation to the scotum prevents ascending of the testis upward after orchiopexy operations. We think this technique decrease the risk of supposed damage to the testicular tissue due to suture material.

The effect of pentoxifylline on the healing of intestinal anastomosis in rats with experimental obstructive jaundice

The aims of this study were (1) to investigate the effect of experimental obstructive jaundice on the healing of intestinal anastomosis, and (2) to investigate the effect of pentoxifylline on the healing of intestinal anastomosis in rats with obstructive jaundice. Obstructive jaundice was induced in rats by the ligation and division of the common bile duct. Four days after this operation, either pentoxifylline or isotonic saline solution was administered intraperitoneally to these jaundiced rats and controls, and then intestinal anastomosis was performed. The concentrations of serum tumor necrosis factor alpha (TNF-alpha) and serum triglyceride of jaundiced and nonjaundiced rats were measured, and the quality of healing was evaluated by measuring the bursting pressure and hydroxyproline content of the anastomoses on the fifth and tenth days of anastomotic healing. Obstructive jaundice resulted in an impaired wound healing of the intestinal anastomosis in the rats. The administration of pentoxifylline to the jaundiced rats resulted in better anastomotic wound healing. The beneficial effects of pentoxifylline on anastomotic healing in rats with obstructive jaundice was attributed to its inhibitor effect on the endotoxin-induced TNF-alpha release from macrophages and monocytes, and the stabilizing effect on the neutrophils.

Huerthle cell neoplasms of the thyroid: predicting malignant potential

OBJECTIVE

Assessment of malignancy criteria in Huerthle cell neoplasm.

METHODS

This study intends to review retrospectively the patients who were operated for Huerthle cell neoplasia at Gazi University, Department of General Surgery between January 1986 and October 1999. Pathological specimens from 63 patients (20 males and 43 females) were investigated in this study, 48 of which revealed Huerthle cell adenoma and 15 revealed Huerthle cell carcinoma. The mean age of the patients with Huerthle cell adenoma was 40.7+/-1.59 yr while it was 51.3+/-1.83 yr in patients with Huerthle cell carcinoma. Mann-Whitney U and Chi-square tests were used for statistical analysis.

RESULTS

. Fifty-two of the 63 patients had fine needle aspiration (FNA) biopsy prior to operation, 49 of those were reported to have suspected Huerthle cell neoplasia (HCN) and three had suspected Huerthle cell carcinoma (HCC). The sensitivity of FNA for HCN was 20 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 76 %. For all patients, peroperative frozen section (FS) biopsy was examined. Fifty-nine of the FS specimens revealed HCN and four revealed HCC. The sensitivity, specificity, positive predictive value and negative predictive value of FS biopsy were 27 %, 79 %, 28.5 % and 77.5 %, respectively. In this retrospective study, there was a statistically significant correlation between malignancy and the size of the tumor (P<0.05) according to Chi-square test, and also a statistically significant correlation between malignancy and the age of the patient (P<0.05) according to Mann-Whitney U test.

CONCLUSIONS

In cases where FS and FNA biopsies cannot adequately define the benign or malignant behaviour of the tumor, the age of the patient and the diameter of the tumor must be taken into consideration for accurate surgical strategy. Particularly for 50 year-old and elderly, incidence of malignancy is statistically significant without considering sex of the patient.

Preoperative fine-needle aspiration cytology versus frozen section in thyroid surgery

OBJECTIVE

In a double blind prospective clinical study to evaluate the diagnostic potential of peroperative fine needle aspiration cytology as compared to peroperative frozen section in thyroid surgery.

METHODS

The diagnostic value of one hundred consecutive preoperative (FNA) and peroperative fine needle aspiration (p-FNA), frozen section (FS) and permanent section (PS) examination for thyroid nodules were studied prospectively in order to assess and compare the accuracy, sensitivity and specificity.

RESULTS

Out of 100 patients PS showed 11 % of malignancies, while p-FNA showed 5 % and FS showed 6% of malignant cases with no false positive, but with 6 and 5 false negative results, respectively. Thus, as compared with FS, one false negative finding was obtained by p-FNA in a case of malignant tumor which could be definitely ascertained by frozen section technique. However, concerning the benign nodules no differences were found between p-FNA and FS.

CONCLUSIONS

Peroperative fine needle aspiration seems to be a useful method which can be properly performed because the nodule can be easily seen during the surgical procedure. However, further clinical observations of large numbers of patients are needed.

Ileal and colonic contractions by endothelin-1 in experimentally induced paralytic ileus in rats

The aim of the present study was to investigate the effect of endothelin-1 on the isolated distal ileum and proximal colon in an experimentally induced ileus in rats. Ileal and colonic contractions by endothelin-1, acetylcholine alone and with endothelin-1 were recorded both in normal and experimentally induced paralytic ileus in rats. In the control group, all the responses to acetylcholine were found to be potentiated significantly when used together with endothelin-1 but in paralytic ileus group, no detectable change was observed in the responses of the amine after administration of acetylcholine together with endothelin-1. This study indicates that endothelin-1 might have an effect on gastrointestinal motility and postoperative paralytic ileus.

Analysis of meatal location in 1,244 healthy men. Definition of the normal site justifies the need for meatal advancement in pediatric anterior hypospadias cases

The normal site of the external urethral meatus on the glans penis and the need for meatal advancement in patients with anterior hypospadias was studied. The location of the external meatus was analyzed in 1,244 men (mean age 28 years) with classification of the meatal position in relation to the tip of the glans and corona. The quality of erections and sexual intercourse, the presence of a penile curvature, urinary stream, and ability to void in a standing position were assessed in an interview. In 1,198 men (96.3%) the meatus was located on the distal third of the glans, in 43 (3.5%) on the middle third, (B), and in 3 (0.2%) on the posterior third. In no case was it located below the corona. One of the 3 men with the meatus on the posterior third had an associated mild penile curvature that did not cause difficulty in sexual intercourse. This study suggests that the normal site of the external meatus is at the tip of the glans. The definition of the normal site and the percentage of men with a normal meatal position justifies the need for meatal advancement in patients with anterior hypospadias when the goals of current hypospadias surgery are considered.

Stress hyperglycemia in minimally invasive surgery

This study examined the selected hormonal responses to, and hormone-mediated glucose metabolism during minimally invasive surgery in, patients undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Thirty-two patients with symptomatic gallstone disease were included in this study and scheduled for open or laparoscopic procedure in a randomized trial. Results are expressed as mean and standard error of the mean. Statistical evaluations were performed with Mann-Whitney U and Wilcoxon signed-rank tests. Blood cortisol, glucagon, insulin, and glucose concentrations were measured immediately in the preoperative period and 6 h after surgery. Blood cortisol, glucagon, and glucose concentrations increased significantly after open and minimally invasive surgery, while insulin levels and the insulin:glucagon ratio remained unchanged. The rise of glucagon and cortisol values was found to be significantly higher in the postoperative period of the open procedure, than in the laparoscopic approach. However, in the patients who underwent open surgery, the increase in glucose concentrations was not significantly higher in the postoperative period. Surgery-induced hormonal effects on the islets increase glucagon and suppress insulin secretion. The glucagon-mediated increase in hepatic glucose production is excluded by the posttraumatic insulin levels from the insulin-sensitive tissues. A bihormonal setting favors a greater rate of hepatic glucose production in both open and laparoscopic surgery. Hormonal changes do reflect the degree of surgical stress, but their metabolic consequences are not parallel to the grade of surgical trauma in minimally invasive surgery.

The cytoprotective effect of iloprost against carbon tetrachloride induced necrosis in rat liver

The aim of this study was to investigate the cytoprotective effect of Iloprost on the liver against carbon tetrachloride induced necrosis. The serum histamine-like activity was found to be increased when compared with that of controls after treatment with carbon tetrachloride for 18 weeks while prostaglandin E2- and leukotriene C4-like activities were unchanged. After pretreatment with Iloprost for 18 weeks the increased activity of histamine was found to be unchanged while prostaglandin E2-like activity was increased. It is concluded that Iloprost protects the liver against carbon tetrachloride-induced damage and reduces the level of histamine that has a role in the pathogenesis of portal hypertension.

The determination of diethylstilbestrol (DES) in the faeces and tissues of chickens treated with DES and in the faeces and tissue samples of calves, lambs and chickens collected from various areas of Turkey

Diethylstilbestrol (DES) analyses were carried out on muscle, liver, kidney and faeces samples of 20 control and 20 experimental broilers to which 5 mg DES/day had been given orally for a period of 7 days. The treated samples were analysed using the Radioimmunoassay method. The removal time of DES from the tissues was determined. Five days following the final administration of DES, its faecal concentration was 151 ppb. However, 7 days after the final administration faecal DES concentrations increased again. On the first day after the final DES administration, DES concentrations in the liver, muscle and kidney were 0.78, 0.74 and 1.33 ppb, respectively. While these values measured on the final day were within the range of the control values. There was an increase of DES in plasma at the end of the experimental period. A total of 1811 muscle, liver, kidney and faeces samples of calves, lambs and chickens and feed samples collected from various areas in Turkey were analysed for the presence of DES. Positive samples for chicken feed was 36.9%. Also 1.9% of the chicken faeces samples were DES positive. All other samples were negative for DES.

Changes in gastric mucosal histamine and prostaglandin E2-like activities in relation to portal somatostatin following small bowel resection in guinea-pigs

The effects of 85% intestinal resection on the portal somatostatin (SLI) gastric mucosal histamine (HA) and prostaglandin E2 (PGE2)-like activities were studied in guinea-pigs. A considerable increase in gastric mucosal HA-like activity of guinea-pigs subjected to small bowel resection (189.9 +/- 15.0 ng/g tissue) was measured in comparison to control values (42.9 +/- 6.3 ng/g tissue) (p < 0.001). The mean tissue PGE2-like activity in the sham operated group was 1636.9 +/- 128.8 ng/g tissue, whereas in the test group it was 650.5 +/- 59.3 ng/g tissue. After 85% small bowel resection a significant fall in portal and systemic venous SLI values was observed (T = 0, p < 0.05). Thus, the small bowel seems to be a major source of the increase of gastric mucosal HA-like activity and the decrease in PGE2-like activity.

[Comparative investigation of compressive resistance of glass-cermet cements used as a core material in post-core systems]

In post-core applications, addition to the cast designs restorations that are performed on fabrication posts with restorative materials are being used. To improve the physical properties of glass-ionomer cements that are popular today, glass-cermet cements have been introduced and those materials have been proposed to be an alternative restorative material in post-core applications. In this study, the compressive resistance of Ketac-Silver as a core material was investigated comparatively with amalgam and composite resins.

An alternate endodontic approach to periapical pathosis

In this article cases involving periapical radiolucencies, which were treated by orthograde amalgam root canal filling, are described. In the obturation phase, with a good condensation of amalgam, the lateral canals and the apical ramifications could be hermetically sealed. This obturation technique is applicable to both nonsurgical and surgical endodontics, saving time and effort.