Künt Karın Travmasına Bağlı Total Pancreas Kırılması: Nadir Bir Vaka Sunumu

A rare case of pancreatic fracture due to blunt trauma was presented. The patient was 70 year old male who had a motor vehicle collision and was suspected a pan-creatic trauma due his examinations with ultrasound and computerized tomogra-phy. The diagnosis of splenic injury and pancreas body total fracture in the point where the portal vein crosses the pancreatic body was made with the help of magnetic resonance cholangiopancreatography. He was taken to emergency sur-gery where a splenectomy and a distal pancreatectomy were performed. We rep-resented this infrequent case of pancreatic fracture and its complications after blunt abdominal trauma and discuss the diagnostic and management practices

The effect of bosentan on plasma ischemia-modified albumin levels in acute mesenteric ischemia

Objective: Our aim in this study was to examine the effects of bosentan, an orally active antagonist of endothelin A and B receptors, on plasma ischemia-modified albumin (IMA) levels in mesenteric ischemia induced rats. Material and Method: In this randomized, controlled trial 36 mature female wistor rats were divided into three groups. Group 1 (n=12) was the control group which only laparotomy was performed. Group 2 (n=12) was the ischemia group and group 3 (n=12) was the bosentan pretreated (100 mg/kg-1 day, 1 gavage/day for two days before surgery) ischemia group. In the ischemia groups (GR 2 and GR 3) following laparotomy the superior mesenteric artery was clamped using a bulldog clamp during laparotomy. Blood samples were taken at 30 minutes from all groups and IMA levels were studied. Results: Plasma IMA levels in the ischemia group (GR 2) was significantly higher compared to those of the control (p<0.001) and bosentan pretreated group (GR 3) (p=0.002). Serum IMA levels were higher in GR 3 than control group but there were no statistical significance (p=0.659). Conclusion: These preliminary results suggest that bosentan might have a protective effect in mesenteric ischemic conditions

A preliminary study: aspirin discontinuation before elective operations; when is the optimal timing?

Purpose: To evaluate the optimum timing of aspirin cessation before noncardiac surgeries. We have conducted a pilot study to minimize the aspirin cessation time before various surgeries. Methods: Eighty patients who were taking regular aspirin for secondary prevention undergoing elective surgical operations were enrolled in the study. We separated the patients into two groups. The control group had 35 patients who stopped aspirin intake 10 days before surgery. The study group had 45 patients who stopped their aspirin intake and underwent surgery one day after arachidonic acid aggregation tests were within normal limits. Bleeding, blood loss, and transfusion requirements were assessed perioperatively. Results: The mean time between aspirin cessation and aspirin nonresponsiveness were found to be 4.2 days with a median value of 4 days. In addition, the mean time between aspirin cessation and operation day were found to be 5.5 days with a median value of 5 days. No perioperative bleeding, thromboembolic or cardiovascular complications were encountered. Conclusion: Reducing time of aspirin cessation from 7-10 days to 4-5 days is a possibility for patients using aspirin for secondary prevention without increased perioperative complications

Five right hepatic vein reconstructions using the autologous saphenous vein in the right lobe living-donor liver transplant: a case report

In living-donor liver transplant, hepatic venous anomalies are not rare. Despite numerous techniques developed over the years, the best way of establishing a patent and durable hepatic drainage system remains controversial. We present a case where we successfully reconstructed 5 hepatic venous structures with a combination of direct anastomosis and saphenous vein interposition. Careful planning before surgery, and a customized approach for the patient on the back table, brought about successful results

Recurrent renal giant leiomyosarcoma

Primary renal leiomyosarcomas are rare, aggressive tumors. They constitute 1-2% of adult malignant renal tumors. Although leiomyosarcomas are the most common histological type (50-60%) of renal sarcomas, information on renal leiomyosarcoma is limited. Local or systemic recurrences are common. The radiological appearance of renal leiomyosarcomas is not specific, therefore renal leiomyosarcoma cannot be distinguished from renal cell carcinoma by imaging methods in all patients. A 74-year-old female patient presented to our clinic complaining of a palpable mass on the right side of her abdomen in November 2012. The abdominal magnetic resonance imaging revealed a mass, 25 x 24 x 23 cm in size. Her past medical history revealed that she has undergone right radical nephrectomy in 2007, due to a 11 x 12 x 13 cm renal mass that was then reported as renal cell carcinoma on abdominal magnetic resonance imaging, but the pathological diagnosis was low-grade renal leiomyosarcoma. The most recent follow-up of the patient was in 2011, with no signs of local recurrence or distant metastases within this four-year period. The patient underwent laparotomy on November 2012, and a 35 cm retroperitoneal mass was excised. The pathological examination of the mass was reported as high-grade leiomyosarcoma. The formation of this giant retroperitoneal mass in 1 year can be explained by the transformation of the lesion’s pathology from low-grade to a high-grade tumor

Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'

Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques. Crystallised phenol application seems to be an alternative therapy to surgery with higher success rates, lower costs, faster recovery and earlier return to work. We aimed to state the success of phenol application for PS in adolescence. A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised. All patients underwent phenol application in an outpatient setting. The patients were followed thereafter. The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus. Crystallised phenol application seems to be a promising non-operative therapy for PS in adolescents. Copyright 2013 BMJ Publishing Group. All rights reserved

The value of copper and zinc levels in hernia formation

Background A defect in collagen metabolism is suspected to be one of the factors responsible for hernia formation. Lysyl oxidase is a copper-dependent enzyme in the process that provides for the structural integrity of collagen molecules, while zinc is essential for tissue maintenance. Materials and methods In a prospective fashion, copper and zinc levels were measured in plasma and tissue specimens obtained from indirect (n = 23), direct (n = 20) and incisional hernia patients (n = 19) and from healthy controls (laparoscopic cholecystectomy patients, n = 15) by enzymatic colorimetric analysis. Results Groups were similar in age, comorbid diseases and body mass index. Whereas plasma levels of Cu and Zn in hernia and control patients were similar, and tissue levels were significantly lower in all hernia groups (especially the incisional hernia group) compared to controls (P < 0 center dot 001). The incisional hernia group had significantly lower tissue copper levels than direct hernia patients and lower zinc levels than indirect hernia patients. Conclusions Patients with all types of hernia, especially those with incisional hernias, have significantly lower tissue copper and zinc levels than control patients, despite having similar plasma levels. This finding might reflect excessive consumption or dysfunction of lysyl oxidase as playing a role in the aetiology of hernias