Parastomal Herni Gelişiminde Kontrol Edilebilir Risk Faktörü; Preoperatif İşaretleme

Aim: Parastomal hernia is one of the most common ostomy-related late complications. Understanding the factors that play a role in development is very important in terms of preventing this complication. In this study, we aimed to determine the factors associated with the development of parastomal hernia and to reveal the relationship between herniation and preoperative stoma site marking. Method: The data of 168 patients who underwent colostomy in our clinic were evaluated retrospectively. Demographic data, body mass index (BMI), malignant or benign disease status, emergency or elective operation, colostomy type, and preoperative stoma site marking were examined. Predictive factors in hernia development were determined by comparing patients with and without parastomal hernia. Results: When the data of 168 patients were examined, the mean age was 59±26.2 years, the female/male ratio was 81/87, and the mean BMI was 29.8±16.2 kg/m2. One hundred eighteen patients (70.2%) had colostomy due to malignancy, and 50 (29.8%) had colostomy due to benign causes. Sixty-three patients (37.5%) were operated under urgent conditions while 105 (62.5%) had elective surgery. Loop colostomy was performed in 40 patients (23.8%) and end colostomy was performed in 128 patients (76.2%). One hundred six patients (63.1%) had preoperative stoma site marking, but 62 (36.9%) were not marked. The incidence of parastomal hernia in the study was 5.95%. Median follow-up was 18 months (11-29 months). Conclusion: High BMI, emergency surgery, end colostomy, and not having preoperative stoma site marking were independent predictive risk factors for parastomal hernia development. Of these, the only controllable factor is preoperative marking. Performing preoperative stoma site marking in all possible cases will contribute to reducing the risk of parastomal hernia.Amaç: Parastomal herni en sık görülen stoma ilişkili geç dönem komplikasyonlardan biridir. Gelişiminde rol oynayan faktörlerinin anlaşılması bu komplikasyonun önlenmesi açısından oldukça önemlidir. Bu çalışmada parastomal herni gelişiminde etkili faktörlerin saptanması ve özellikle preoperatif stoma yeri işaretlemesi ile herni gelişimi arasındaki ilişkinin ortaya konulması hedeflenmiştir. Yöntem: Kliniğimizde kolostomi açılan 168 hastanın verileri retrospektif olarak değerlendirildi. Demografik veriler, vücut kitle indeksi (VKİ), malign veya benign hastalık durumu, ameliyatın acil veya elektif yapılması, kolostomi tipi ve preoperatif stoma yeri işaretlemesi yapılıp yapılmadığı incelendi. Parastomal herni gelişen ve gelişmeyen hastalar karşılaştırılarak herni gelişiminde etkili prediktif faktörler tespit edildi. Bulgular: Yüz altmış sekiz hastanın verileri incelendiğinde yaş ortalaması 59±26,2 yıl, kadın/erkek oranı 81/87, VKİ ortalaması ise 29,8±16,2 kg/m2 olarak hesaplandı. Yüz on sekiz (%70,2) hastada malignite nedeniyle, 50 hastada (%29,8) benign nedenlerden dolayı kolostomi açıldığı görüldü. Yüz beş (%62,5) hasta elektif şartlarda ameliyat edilmişken 63 hasta (%37,5) acil şartlarda ameliyat edilmişti. Hastaların 40’ında (%23,8) loop kolostomi, 128’inde (%76,2) uç kolostomi mevcuttu. Yüz altı (%63,1) hastada preoperatif stoma yeri işaretlenmişken 62 (%36,9) hastada işaretleme yapılmadığı görüldü. Çalışmadaki parastomal herni insidansı %5,95 olarak saptandı. Medyan takip süresi 18 aydı (11-29 ay). Sonuç: Artmış VKİ, acil ameliyat, uç kolostomi tipi ve stoma yerinin işaretlenmemesi parastomal herni gelişimi için bağımsız prediktif risk faktörleri olarak saptanmıştır. Bu değişkenler içerisinde kontrol altına alınabilir tek faktör preoperatif işaretlemedir. Mümkün olan tüm hastalarda preoperatif stoma yeri işaretlemesinin yapılması parastomal herni riskinin azaltılmasına katkı sağlayacaktır

Agreement Between Pathologic Diagnosis and Endoscopic Findings on Esophagogastroduodenoscopy Performed by General Surgeons

Aim: The aim of this study is to evaluate cognitive competence of surgeon-endoscopists in esophagogastroduodenoscopy (EGD) by comparison between endoscopic and pathologic diagnosis. Methods: This study is a retrospective chart review of 257 EGDs performed between September 2008 and March 2010 by two attending surgeons (OI, FAG) at the Zonguldak Karaelmas University, Medical Faculty, Department of General Surgery. Cognitive competence was examined by comparison between endoscopic and histopathological diagnosis. Endoscopic and pathologic reports were collected from the hospital database. Results: 217 of 257 EGDs were evaluated. Demographic data of the patients showed that 36% were male and 64% were female. The mean age was 51 years with a range of 24 to 78 years. Endoscopic diagnosis was gastritis in 78% of patients (n=168) and suspicion of malignancy in 11% (n=25). After histopathologic examination, 142 out of 168 patients with endoscopically suspected gastritis were diagnosed as having chronic gastritis or chronic-active gastritis. Surgeons were able to identify an abnormality with a detection rate of 86%. Surgeon-endoscopists had 80% positive predictive and 100% negative predictive value for malignancy according to EGD findings. H. pylori-positive gastric mucosal pattern was accurately identified by surgeons, and the infection was found in 67% (n=112) of patients with chronic gastritis or chronic-active gastritis. Conclusion: Taking into consideration the good agreement observed between endoscopic and pathologic findings in our study, we may conclude that surgeon-endoscopists with high cognitive competence in EGD may establish accurate diagnosis. (The Medical Bulletin of Haseki 2011; 49: 26-9

A Rare cause of acute abdomen: Idiopathic necrosis of the fourth part of the duodenum

Duodenum nekrozu peritonit nedenlerinden biridir. İyi bilinen ve mutlak girişim gerektiren cerrahi acillerdendir. Çoğunlukla cerrahi sonrası duodenum güdüğünün kanlanmasının iyatrojenik nedenlere bağlı bozulması veya nekrotizan pankreatit sonucu gelişmektedir. Bu yazıda akut karın bulguları acil servise başvuran herhangi bir etiyolojik neden saptanmaksızın duodenumun 4. kısmında nekroz tespit edilen 69 yaşında kadın hasta sunulmuştur. Çekilen abdominal bilgisayarlı tomografisinde anormal değişiklikler saptanmış ve laparatomi yapılan hasta tüp duodenostomi uygulanarak başarılı bir şekilde tedavi edilmiştir. (Gazi Med J 2012; 23: 29-32)Duodenal necrosis is one of the causes of peritonitis. It remains a well-known surgical emergency requiring prompt surgical intervention. Duodenal necrosis mostly occurs following iatrogenic devascularisation of a duodenal stump or in the course of necrotising pancreatitis. We present a case of idiopathic necrosis of the fourth part of the duodenum without a certain aetiologic cause in a 69-year-old woman who was admitted to our hospital with acute abdomen findings. Abdominal computed tomography scan revealed abnormal results. Laparotomy was performed and the case was successfully treated with tube duodenostomy. (Gazi Med J 2012; 23: 29-32

Effects of Ozonated Olive Oil on Acute Radiation Proctitis in Rats

Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats.Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats

The results of postoperative chemoradiotheapy in gastric carcinoma patients: Bulent ecevit university experience

Amaç: Mide kanseri tanısıyla postoperatif kemoradyoterapi uyguladığımız olgularımızın tedavi sonuçları değerlendirildi. Gereç ve Yöntem: 2007-2011 yılları arasında postoperatif kemoradyoterapi uygulanan toplam 77 mide kanseri tanı- lı olgu geriye dönük olarak incelendi. Kemoradyoterapi, Intergroup-0116 çalışma protokolüne göre uygulandı. Üç boyutlu konformal planlama sonrası mide loju ve bölgesel lenfatiklere 45 Gy, cerrahi sınır pozitif olanlara 50.4 Gy radyoterapi verildi. Bulgular: Olguların 46’si erkek (% 59.7), 31’i kadın (% 40.3) olup, ortanca yaş 59 (dağılım 31-78) idi. Ortanca genel sağkalım ve hastalıksız sağkalım süreleri sırasıyla 28.3 ve 21 aydı. Üç yıllık genel ve hastalıksız sağkalım oranları sı- rasıyla % 43.8 ve % 41.7 bulundu. Takipleri sırasında 10 olguda (% 13) lokal-bölgesel yineleme, 22 olguda (% 28.6) uzak organ metastazı, 3 olguda (% 3.9) ise hem lokal- bölgesel yineleme hem de uzak organ metastazı saptandı. Kemoradyoterapi süresi boyunca grad 1-2 hematolojik yan etki 23 (% 30) olguda, 3-4 hematolojik yan etki 46 (% 59.7) olguda, grad 1-2 gastrointestinal yan etki 30 (% 39) olgu- da, grad 3-4 gastrointestinal yan etki 11 (% 14.3) olguda görüldü. Tek değişkenli analizde lenf nodu evresi ve lenf nodu tutulum oranı hem genel hem de hastalıksız sağkalım üzerine etkili prognostik faktörler olarak bulunurken, çok değişkenli analizde lenf nodu diseksiyon tipi ve lenf nodu tutulum oranı genel ve hastalıksız sağkalım ile ilişkili prog- nostik faktörler olarak bulundu. Sonuç: Kemoradyoterapinin lokal kontrol üzerinde etkili olduğu, uzak metastaz gelişimini engellemede ise yetersiz kaldığı saptanmıştır. Erken dönem özellikle hematolojik yan etkiler sık gözlenmiştir.Objective: The treatment results of postopeative chemoradi- otherapy in patients with gastric carcinoma were evaluated. Material and Methods: A total of 77 patients with gast- ric carcinoma, treated with postoperative chemoradiothe- rapy between 2007-2011, were evaluated retrospectively. Chemoradiotherapy was applied in accordance with the Integroup-0116 study protocol. Total 45 Gy radiotherapy was delivered to the gastric bed and regional lymphatic no- des and 50.4 Gy was given to patients with positive surgical margins after 3-dimensional conformal planning. Results: Forty-six of the patients were male (59.7 %), and 31 of the patients were female (40.3 %) with a median age of 59 (31-78). Median overall survival and disease-fee sur- vival were 28.3, and 21 months, respectively. The 3-year overall and disease-free survival rates were 43.8 % and 41.7 %, respectively. Locoregional recurrence was detected in 10 (13 %), distant metastasis was detected in 22 (28.6 %) and both locoregional and distant metastasis were detected in 3 (3.9 %) of patients. During chemoradiotherapy grade 1-2 hematological toxicity was seen in 23 (30 %) patients, grade 3-4 hematological toxicity in 46 (59.7 %) patients, grade 1-2 gastrointestinal toxicity in 30 (39 %) patients, and grade 3-4 gastrointestinal toxicity in 11 (14.3 %) pa- tients. While in the univariate analysis lymph node stage and percentage of positive lymph nodes were found to be prognostic factors for overall and disease-free survival, in the multivariate analysis type of lymph node dissection and percentage of positive lymph nodes were found to be prog- nostic factors that are correlated with overall and disease- free survival. Conclusion: Chemoradiotherapy improved loco-regional control rather than reduction of distant metastases. Acute es- pecially hematologic side effects were commonly observed

Does intraabdominal use of Ankaferd Blood Stopper cause increased intraperitoneal adhesions?

Ankarali, Handan Camdeviren/0000-0002-3613-0523; Gultekin, Fatma Ayca/0000-0002-4148-5871; Cakmak, Guldeniz Karadeniz/0000-0001-5802-4441; Emre, Ali Ugur/0000-0002-1136-0517; Karakaya, Kemal/0000-0002-6742-9923WOS: 000281963300001PubMed: 21038113BACKGROUND The aim of this study was to investigate whether intraabdominal Ankaferd Blood Stopper (ABS) causes increased intraabdominal adhesion formation and to determine any side effects of ABS in vivo. METHODS The present experimental study was designed to examine the effects of Ankaferd solution on peritoneal adhesion formation in a rat model of cecal abrasion. Intraperitoneal adhesions were assessed macroscopically and histopathologically on the 10th postoperative day. The possible adverse affects of ABS on liver and lung tissues were analyzed histopathologically, and blood chemistry was also evaluated. RESULTS Our study revealed that ABS reduced intraperitoneal adhesion formation in an experimental rat model. The blood chemistry was not disturbed due to ABS administration. Intraperitoneal administration of ABS led to some minor changes in the lungs and serosal surfaces of the intestines, with minor architectural changes in the liver that were not considered as toxic. Further studies with various application doses and routes with more detailed cellular analysis are thus warranted to clarify the possible pleiotropic and adverse effects of this new agent away from hemostasis. CONCLUSION There was less intraperitoneal adhesion formation in the ABS group than in the control group and saline group. Intraperitoneal administration of ABS has no toxic effects on blood chemistry or the lungs, kidneys and the liver, but it has some minor adverse effects

Agreement between pathologic diagnosis and endoscopic findings on esophagogastroduodenoscopy performed by general surgeons

Amaç: Çalışmanın amacı genel cerrah-endoskopistler tarafından gerçekleştirilen özefagogastroduodoneskopilerde (ÖGD) kognitif yeterliliğin endoskopik tanı ve patolojik tanıyla karşılaştırılarak değerlendirilmesidir. Yöntemler: Veriler, Eylül 2008 ve Mart 2010 tarihleri arasında Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Genel Cerrahi ABD Endoskopi Ünitesinde çalışan 2 endoskopist-genel cerrah (Ol, FAG) tarafından gerçekleştirilen 257 ÖGD işleminin ve patoloji raporlarının retrospektif olarak incelenmesi ile elde edilmiştir. Endoskopi ve patoloji raporları hastane bilgi işletim sisteminden elde edilmiştir. Bulgular: iki yüz elli yedi ÖGD işleminden 217'si değerlendirilmiştir. Hastaların %36'sı erkek ve %64'ü kadındı. Ortalama yaş 51 yıl olup, 24 ile 78 yaş arasında değişim gösterdiği gözlendi. Yapılan endoskopik incelemelerde hastaların %78'inde (n=168) gastrit (antral-pangastrit) ile uyumlu görüntü, %11'inde (n=25) malign patolojiyi düşündüren görüntü tespit edilmiştir. Histopatolojik inceleme sonrası gastrit olduğu düşünülen 168 hastanın 142'sinde patolojik tanı, kronik gastrit, kronik-aktif gastrit şeklinde gelmiştir. Cerrahların endoskopideki anormal bulguları %86 oranında yakaladıkları tespit edilmiştir. Endoskopik tanılar ile patolojik veriler arasındaki uyum değerlendirildiğinde, endoskopistlerin ÖGD'deki görüntüye göre malign lezyonları değerlendirmede %80 oranında pozitif prediktif ve %100 oranında da negatif prediktif değere sahip oldukları tespit edilmiştir. Helicobacter pylori pozitif gastrik mukozal patern endoskopist cerrahlar tarafından tanınmış ve kronik gastrit veya kronik-aktif gastrit tanısı olan hastaların %67'de (n=112) H. pylori nin pozitif olduğu görülmüştür. Bulgular: Endoskopik ve patolojik tanı arasındaki uyum göz önüne alındığında; endoskopik-cerrahlar ÖGD bulgularını uygun bir şekilde değerlendirerek doğru tanı koyabilmektedirler. (Haseki Tıp Bülteni 2011;49:26-9)Aim: The aim of this study is to evaluate cognitive competence of surgeon-endoscopists in esophagogastroduodenoscopy (EGD) by comparison between endoscopic and pathologic diagnosis. Methods: This study is a retrospective chart review of 257 EGDs performed between September 2008 and March 2010 by two attending surgeons (Ol, FAG) at the Zonguldak Karaelmas University, Medical Faculty, Department of General Surgery. Cognitive competence was examined by comparison between endoscopic and histopathological diagnosis. Endoscopic and pathologic reports were collected from the hospital database. Results: 217 of 257 EGDs were evaluated. Demographic data of the patients showed that 36% were male and 64% were female. The mean age was 51 years with a range of 24 to 78 years. Endoscopic diagnosis was gastritis in 78% of patients (n=168) and suspicion of malignancy in 11% (n=25). After histopathologic examination, 142 out of 168 patients with endoscopically suspected gastritis were diagnosed as having chronic gastritis or chronic-active gastritis. Surgeons were able to identify an abnormality with a detection rate of 86%. Surgeon-endoscopists had 80% positive predictive and 100% negative predictive value for malignancy according to EGD findings. H. pylori-positive gastric mucosal pattern was accurately identified by surgeons, and the infection was found in 67% (n=112) of patients with chronic gastritis or chronic-active gastritis. Conclusion: Taking into consideration the good agreement observed between endoscopic and pathologic findings in our study, we may conclude that surgeon-endoscopists with high cognitive competence in EGD may establish accurate diagnosis. (The Medical Bulletin of Haseki 2011; 49:26-9) Key Words: Esophagogastroduodenoscopy, cognitive competence, general surgeo

Ankaferd Blood Stopper’in karın içi kullanımı periton içi yapışıklık oluşumunu arttırır mı?

AMAÇ Bu çalışmanın amacı, karın içi kullanılan Ankaferd Blood Stopper’in (ABS) periton içi yapışıklık oluşumunu arttırıp arttırmadığını ve in vivo kullanıma bağlı majör toksik etkilerini irdelemektir. GEREÇ VE YÖNTEM Bu deneysel çalışma, çekal abrazyon uygulanan sıçan modelinde Ankaferd solüsyonunun periton içi yapışıklık oluşumu üzerine etkisini değerlendirmek üzere dizayn edildi. Periton içi yapışıklıklar cerrahi uygulama sonrası 10. gün makroskopik ve histopatolojik inceleme ile belirlendi. Yan etki varlığını irdelemek için kan, akciğer ve karaciğer dokuları alındı. BULGULAR Ankaferd Blood Stopper’in kullanımı ile karın içi yapışıklık oluşumunun azaldığı görüldü. ABS uygulanmasının kan biyokimyasal incelemelerinde herhangi bir bozulmaya neden olmadığı saptandı. Ancak akciğerlerde ve bağırsakların serozal yüzeylerinde akut ve kronik enflamatuvar değişiklikler ve karaciğerde minör yapısal değişiklikler izlendi. Bu değişikliklerin hiçbiri toksik değişiklik olarak değerlendirilmedi. ABS’nin diğer etkilerinin belirlenmesi için farklı dozlarda ve farklı klinik senaryolarda ileri çalışmalara ihtiyaç vardır. SONUÇ Periton içi yapışıklık oluşumu ABS uygulanan grupta kontrol grubu ve SF grubuna kıyasla daha az görüldü. İntraperitoneal ABS kullanıma bağlı olarak herhangi bir toksik etki saptanmamakla birlikte bazı minör değişiklikler gözlenmiştir.BACKGROUND The aim of this study was to investigate whether intraabdominal Ankaferd Blood Stopper (ABS) causes increased intraabdominal adhesion formation and to determine any side effects of ABS in vivo. METHODS The present experimental study was designed to examine the effects of Ankaferd solution on peritoneal adhesion formation in a rat model of cecal abrasion. Intraperitoneal adhesions were assessed macroscopically and histopathologically on the 10th postoperative day. The possible adverse affects of ABS on liver and lung tissues were analyzed histopathologically, and blood chemistry was also evaluated. RESULTS Our study revealed that ABS reduced intraperitoneal adhesion formation in an experimental rat model. The blood chemistry was not disturbed due to ABS administration. Intraperitoneal administration of ABS led to some minor changes in the lungs and serosal surfaces of the intestines, with minor architectural changes in the liver that were not considered as toxic. Further studies with various application doses and routes with more detailed cellular analysis are thus warranted to clarify the possible pleiotropic and adverse effects of this new agent away from hemostasis. CONCLUSION There was less intraperitoneal adhesion formation in the ABS group than in the control group and saline group. Intraperitoneal administration of ABS has no toxic effects on blood chemistry or the lungs, kidneys and the liver, but it has some minor adverse effects