The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis

Thyroid fine needle aspiration reporting rates and outcomes before and after Bethesda implementation: A single-center experience over 8 years

Aimː To evaluate data from our hospital system before and after the implementation of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) and comparison of our data with the previously published studies. Methods: Seven hundred seventy-one patients with thyroid nodules who underwent fine needle aspiration biopsy (FNAB) and surgery at our institution were analyzed retrospectively. FNAB results were divided into two parts in terms of the period they related to: pre-TBSRTC (between 2005 and 2010) and TBSRTC (between 2011 and 2013). Results: 341 FNAB were applied in the period of TBSRTC. Of the 341 FNAB, 53(16%) were non diagnostic, 82(24%) were benign, 62(18%) were atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 28(8%) were follicular neoplasms and/or suspicion of follicular neoplasms (FN/SFN), 95(28%) were suspicion for malignancy (SuspM), and 21(6%) were malignant. Rates of malignancy reported on follow-up histopathological examination were non diagnostic in 11%, benign in 4.9%, AUS/FLUS in 23%, FN/SFN in 32%, SuspM in 44%, and malignant in 95.3%. Conclusions: In this study, the distribution of cases in TBSRTC categories and malignancy rates, differed from, recommended by TBSRTC and some studies. Implementation of TBSRTC did significantly affect our institution’s reporting rates

Effects of evening primrose oil and 5-fluorouracil on the healing of colonic anastomoses in rats

Aim: This study was designed to evaluate the efficacy of evening primrose oil (EPO) on colonic anastomosis. Methods: Sixty rats with colonic anastomosis were randomly divided into six groups. EPO and 5-Fluorouracil (5-FU) were administered at doses of 5 g/kg/day and 20 mg/kg/day, respectively.  Group 1 served as sham control. The rats in Group 2 (EPO) received EPO (14 days preoperatively), in Group 3 (Extended EPO) received EPO (14 days preoperatively and 7 days postoperatively), in Group 4 (5-FU) received intraperitoneally 5-FU (5 days preoperatively), in Group 5 (5-FU+EPO) received EPO (14 days preoperatively), and 5-FU (5 days preoperatively), in Group 6 (5-FU+ extended EPO) received EPO (14 days preoperatively and 7 days postoperatively)  and 5-FU (5 days preoperatively). Histopathological examination, bursting pressure, and hydroxyproline content were used for evaluation. Results: Significant differences were found between the Groups 1, 2, and 3 and Groups 4, 5, and 6 in bursting pressures. Polymorphonuclear leukocyte (PMNL) and lymphocyte infiltration was significantly less in group 3, compared to the control and group 2. The least PMNL infiltration was in group 6 compared to groups 4 and 5.  The hydroxyproline level was different in group 3 compared to the control and group 2. Furthermore, groups 5 and 6 were different compared to group 4. Conclusion: EPO had favorable effects on colonic anastomosis even in groups where 5-FU was used

Karaciğer hidatik kistleri tedavisinde güncel yaklaşımlar

Karaciğer kist hidatikleri tedavisinde temel prensipler, hastalığa sebep olan parazitin ara konak formunun öldürülmesi ve/veya vücuttan uzaklaştırılması, kistin yol açabileceği komplikasyonların önlenmesi boşaltılması ve sorunsuz kapanmasının sağlanmasıdır. İdeal tedavi hem hastalığın iyileştirilmesini tam olarak sağlamalı, hem de morbidite-mortalitesi minimal olmalıdır.Main principles in the teratment of liver hydatid cysts are to kill and/or to remove the intermediate host form of the parasite which has caused the disease, to prevent the complications which the cyst may cause, evacuation of the cyst and to ensure a trouble-free closure. The ideal treatment should provide not only a full irecovery but also minimal morbidity and mortality

Shouldice herniorrhaphy technique : Surgeons need to remember it

Amaç: Genel cerrahların; acil dışındaki ameliyatlar arasında, en fazla yaptıkları ikinci sırada yer alan ameliyat fıtık onarımıdır. Shouldice herniorafi klasik ameliyatlardan biri olup gerilimli olarak adlandırılan ameliyat sınıfında yer almaktadır. Bu ameliyat her cerrahın repertuarında bulunmalıdır. Cerraha bir alternatif sağladığı gibi, gerilimsiz tekniklerin uygulanamayacağı vakalarda kullanımı zorunlu hale gelebilir. Bu çalışmada Lichtenstein herniorafi ve Shouldice herniorafi arasındaki avantaj ,dezavantaj ve komplikasyonlarını literatür eşliğinde inceledik. Gereç ve Yöntem: Hastanemizde yapılan Lichtenstein herniorafi ve seçilmiş hastalardaki Shouldice herniorafi vakalarını karşılaştırdık. Nisan 2007-mayıs 2008 tarihleri arasında inguinal herni tanısıyla Samsun Bafra Devlet Hastanesi Genel Cerrahi Servisi’nde Lichtenstein herniorafi yapılan 75 hasta ile Shouldice herniorafi yapılan 33 hasta takibe alınmıştır. Hastaların yaş-cins dağılımı, herni tipi, anestezi şekli, ortalama yatış süresi, erken ve geç komplikasyonları incelenmiştir. Bulgular: Postoperatif dönemdeki erken komplikasyonlar; idrar retansiyonu, yara enfeksiyonu ve hematom gelişmesi olarak gözlenmiştir. İdrar retansiyonu gelişen hastaların hepsine spinal anestezi uygulanmış olup, geçici idrar sondası takılması gerekti. Yüzeyel yara enfeksiyonu drenaj ve antibiyoterapi ile tedavi edildi. Hastaların geç dönem komplikasyonları incelendiğinde Schouldice herniorafi yapılan 1 hastada uylukta parestezi, lichtenstein herniorafi yapılan 1 hastada postoperatif 5.ayda nüks gelişti. Sonuç: Her cerrahın bilmesi gerektiğini düşündüğümüz bu tekniğin cerrahi eğitimi veren kurumlarda yeni yetişen cerrahlara alternatif bir yöntem olarak verilmesi gerektiğini düşünüyoruz. Cerrahiye bir alternatif sağladığı gibi, gerilimsiz tekniklerin uygulanamayacağı vakalarda doğrudan tercih edilebilir.Aim: Hernia surgery is the second most common surgical intervention performed by general surgeons following emergent surgeries. Shouldice herniorraphy is a classical surgery which is in the high tension repair group. This technique should be known by every surgeon. Also being an alternative method, it can be a necessity in cases in which tension free methods can not be performed. In the present study we investigated the advantages, disadvantages and complications of the Shouldice herniorraphy and Lichtenstein technique with the review of the technical literature. Material and Method: We compared 75 patients who were diagnosed with inguinal hernia and treated with Lichtenstein herniorraphy with 33 patients who were treated with Shouldice herniorraphy in Samsun Bafra Public Hospital between April 2007 and May 2008. Age, sex, hernia type, anesthesia method, mean hospitalisation length, early and late post operative complications were recorded. Result: Early post operative complications were urinary retention, wound infection and hematoma. The patients under spinal anesthesia with urinary retention were treated with urinary catheterization. Superficial wound infection was treated with drainage and antibiotic threapy. Among late postoperative complications; we observed paresthesia in the thigh in one patient in the Shouldice group and relapse hernia in one patient in the Lichtenstein group. Discussion: We suggest that this surgical technique which should be known by every surgeon should be taught to new surgery attenders as an alternative technique. This technique can be an alternative method and also may be the first choice in patients in whom tension free methods can not be applicated

Intrabiliary rupture: An algorithm in the treatment of controversial complication of hepatic hydatidosis

AIM: Intrabiliary rupture (IBR) is a common and serious compli-cation of hepatic hydatid cyst. The incidence varies from 1% to 25%. The treatment of IBR is still controversial. We aimed to design an algorithm for the treatment of hepatic hydatidosis with IBR by reviewing our cases

Laparoscopic cholecystectomy results in patients with different age groups

Amaç Laparoskopik kolesistektomi benign safra kesesi hastalıklarında en çok tercih edilen metod olmuştur. İleri yaş ,mortalite ve morbiditenin artmasına neden olur. Bu çalışmanın amacı farklı yaşlardaki hastalarda laparoskopik kolesistektominin sonuçlarını karşılaştırmakır (yaş yaş). Gereç ve Yöntemler Kasım 2001-Mayıs 2009 tarihleri arasında OMÜ Tıp Fakültesi ve Mustafa Kemal Üniversitesi Tıp Fakültesinde benign safra kesesi hastalığı nedeniyle laparoskopik kolesistektomi uygulanan toplam 511 hasta retrospektif olarak analize edildi. Hastalar yaşlarına göre 3 gruba bölündü. Grup A (,n=96). Bulgular Tüm gruplarda laparoskopik kolesistektomi için en sık endikasyon semtomatik kolelitiazisdir. Ko-morbit hastalılar Grup C’de, Grup A ve B’ye göre anlamlı olarak daha yüksekti.İnsidental bilier patolojiler ve abdominal operasyon öyküsü tüm gruplarda benzer şekildeydi. Bununla birlikte bilier kanal ve sistik arter anomalileri Grup A’da,Grup B ve C’ ye göre anlamlı olarak yüksek bulundu. Bu çalışmada 26 hastada (%5.08) açık kolesistektomiye dönmek gerekti. Açığa dönüşün en büyük nedeni Callot üçgeni zor diseksiyonu idi( 21 hastada ;%80). Gruplar arasında morbidite açısından farklılık yoktu. Sonuç Sonuç olarak, genç hastalarda safra yolu anomalilerinin ve yaşlı hastalarda ko-morbid bozuklukların daha yaygın olduğu düşünülmelidir. Bu faktörler hastanın preoperatif iyi değerlendirilmesi sonucu etkilemez. Bununla birlikte cerrah bu durumun farkında olmalı ve intraoperatif ve postoperatif komplikasyonlar nedeniyle dikkatli olmalıdır.Aim Laparoscopic cholecystectomy (LC) has been most preferable method for benign gallbladder disease. Advanced age may be increased morbidity and mortality. The aim of this study was to compare the results of LC in patients according to different ages (age ≤ 30, 31 – 64 years, and age ≥ 65). Material and Methods A retrospective analysis was performed including overall 511 patients who underwent LC for benign disease of gallbladder at Ondokuzmayis University Medical Faculty and Mustafa Kemal University, Medical Faculty between November 2001 and November 2009. The patients are divided into three groups according to ages: Group A (age ≤ 30 years, n = 47), Group B (age = 31 – 64 years, n = 368), Group C (age ≥ 65, n = 96). Results Symptomatic cholelithiasis was the most common indication for LC in all the groups (p > 0.05). Co-morbid diseases were significantly higher in the Group C (≥ 65 years) than in the Group A and B (≤ 30 years, 31 - 64 years) (p=0.001). Co-incidental biliary pathologies, and history of abdominal operation were similar in all the groups. However biliary duct and cystic artery anomalies were significantly more common in the Group A than in the Group B and C (p=0.001). Conversion to OC was required in 26 (5.08 %) patients in this study. The major reason for the (21 cases, 80.76 %) was difficult dissection of the Calot’s triangle. There was no difference in morbidity among the groups (p>0.05). Conclusions As a conclusion, it’s thought that biliary anomalies in young patients and co-morbid diseases disorders in elderly patients are more common. These factors do not affect the results of patient that preoperatively well evaluated. However surgeon should be aware of this condition and be careful for intraoperative and postoperative complication