Laparoscopic surgery for complex and recurrent Crohn's disease

Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70\% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.4APR 16149-152

The structural situation of the dairy cattle farms in Kahramanmaraş province 4 social and cultural sitiation in farmers

Bu çalışmada Kahramanmaraş ilindeki süt sığırcılığı işletmecilerinin sosyal ve kültürel durumları incelenmiştir. İl genelinde işletme başına büyükbaş hayvan sayısı 3.55, küçükbaş hayvan sayısı ise 8.61 olarak hesaplanmıştır. İşletme başına arazi genişliği hem bitkisel hem de hayvansal üretim yapan işletmelerde 50 dekar, tüm tarımsal sadece hayvancılık yapan işletmelerde ise 48 dekar olarak hesaplanmıştır. Ankete tabi tutulan işletmelerde ortalama büyüklük 9.09 BBHB’dir. İşletmelerde tutulan hayvanların %30’u yerli, %48’i melez ve %22’si kültür ırkı şeklindedir. Anket yapılan işletmecilerin %43’ü ilkokul mezunu, %9’u okur-yazar değil, %26’sı ortaokul, %21’i lise ve %1’i üniversite mezunudur. İşletmecilerin %97’ si radyoya, %100’ü TV’ye, %91’i cep telefonuna sahiptir. İşletmelerde traktöre sahip olma oranı %51, özel otomobile sahip olma oranı ise %49 olarak bulunmuştur. İşletmecilerin %25’i günlük gazeteye abonedir, %8’i hayvancılıkla ilgili bir okuma materyaline ulaşmaktadır. Tarım ile ilgili TV kanalı izleme oranı ise %48’dir.This study was carried out to determine the social and cultural structure in Kahramanmaraş dairy cattle farms. Generally, the number of sheep and goat, and cattle per family determined as 8.61 and 3.55, respectively. The size of holdings land per family engaged in both crop production and animal husbandry, and only animal husbandry was 50 decares and 48 decares, respectively. According to invistigation, average nuber of agricultural holdings was 9.09 BBHB. Current cattle breeds in farms were 30 % of native breeds, 48 % cross breeds and 22% were cultural breeds. It was determined that 43% of the farm owners is education was primary school; 9% did not go to school; 26% secondary school, 21% high school and 1% university. 97% of the farmers have radio; 91% of them use gsm, 100% of them have TV. 51% of the farmers have tractor and 49% of them use private otomobil. 25% of the farmers read daily newspaper; 8% of them read animal related material; 48% of them follow agricultural TV channel

Perception of Risk Factors and Determination of Risk Management Strategies According to Agricultural Enterprise Typologies

In this study, it was aimed to determine the risk management strategies and the level of risk perception of the entrepreneurs in agricultural enterprises classified according to production activities. Risk behaviours of entrepreneurs were examined according to the enterprise typologies, and the reference game was used for this purpose. The success of the economic activities of the enterprises was determined by an analysis of the annual operating results. The risk perception was investigated according to the enterprise typology. As a result, it was determined to be perceived as risk factors: drought, fluctuation of input and product prices in the livestock enterprises; drought, precipitation, pests, frost and hail in the mixed plant enterprises; drought, precipitation, frost and hail in the mixed plant and livestock enterprises; pest, diseases, hail, drought and precipitation in the specialized perennial enterprises; storm, capital shortage, loans, price fluctuation, yield fluctuation and fire in the specialized horticulture enterprises; drought, frost, hail, insufficient and unpredictable precipitation in the crop enterprises. The general information on agricultural issues, the implementation of new farming techniques, the diversity in production, the planned debt, the contract production, agricultural protection and the market follow were found out as management strategies for these risk factors

Cost Analysis in Patients Treated with Partial Laryngectomy

Objective:The aim of this study was to conduct a cost analysis in patients treated with partial laryngectomy surgery due to laryngeal carcinoma.Methods:The length of stay, complication rates, decannulation time, time to initiate oral nutrition, costs of examination, medication costs and total cost were assessed by investigating the records and bills of 26 patients with larynx squamous-cell carcinoma treated with frontolateral, supraglottic and supracricoid laryngectomy surgery in the Ear-Nose-Throat Clinic of the Şişli Etfal Research and Training Hospital between January 2007 and December 2011.Results:Frontolateral laryngectomy was performed in 11 of 26 patients, supraglottic laryngectomy was performed in 8 of these patients and supracricoid laryngectomy was performed in 7 of these patients. Complications were observed in one of these 26 patients. When the costs of diagnostic tests/treatments of these three surgical methods were compared, supracricoid laryngectomy was found to be the most expensive method (p<0.05). Drug costs in this set of patients were significantly higher than in the frontolateral and supraglottic laryngectomy group (p<0.05). The total cost of the supracricoid laryngectomy group was significantly higher than that of the supraglottic and frontolateral laryngectomy group (p<0.05). Length of stay in the supracricoid laryngectomy group was significantly higher than that of the frontolateral and supraglottic laryngectomy group (p<0.05). In terms of decannulation times, although there was no significant difference between the supracricoid and supraglottic laryngectomy groups, the decannulation time was significantly lower in the frontolateral laryngectomy group (p<0.05). While the initiation time of oral nutrition was longest in the supracricoid and supraglottic laryngectomy groups, there was no significant difference between them. The initiation time of oral nutrition was significantly lower in the frontolateral laryngectomy group (p<0.05).Conclusion:The length of stay following partial laryngectomy due to squamous-cell carcinoma of the larynx can be prolonged due to the longer decannulation time and the longer initiation time of oral nutrition. To overcome these problems, particularly in supracricoid laryngectomy, action to prevent complications and precautions that can be taken during surgery will seriously reduce costs

Comparison of the Postoperative Mucociliary Clearance Time Between Patients who Underwent Septoplasty with and Without Nasal Packing

Objective:To compare the postoperative mucociliary clearance time in septoplasty with and without nasal packing.Methods:Forty-six patients with nasal septal deviation (20 women, 26 men) were assessed in this study. The patients underwent septoplasty under local anaesthesia. Patients were divided in two groups. Merocell® nasal packing was performed in both of the nasal passages for septum stabilization in the first group (28 patients). On the second postoperative day nasal packing was removed and salin irrigation solution was started. Transseptal suturing was performed for nasal stabilization in the second group and at the sixth postoperative hour saline irrigation solution was started. Saccarine clearance test was performed preoperatively and postoperatively at the 7th day, and 3th month and the results were compared.Results:In the treatment of 46 patients with a mean age of 20-53, in the first group; preoperative mucociliary clearance time on the deviated side was 12.2 minutes and on the opposite side was 13.1 minutes. In the second group, preoperative mucociliary clearance time on the deviated side was 11.9 minutes, and on the opposite side 12.8 minutes. In the first group, the postoperative 1th week mucociliary clearance time on the deviated side was 12.5 minutes and on the opposite side was 13.2 minutes and in the second group on the deviated side was 10.1 minutes, and on the opposite side was 10.8 minutes. In the first group, at the postoperative 3th month mucociliary clearance time on the deviated side was 11.6 minutes and on the opposite side was 11.4 minutes while in the second group on the deviated side was 6.7 minutes, and on the opposite side was 7.8 minutes.Conclusion:The postoperative mucociliary clearance time in patients treated for septal deviation were evaluated. We have determined that the mucociliary clearance time was longer in the patients that underwent septoplasty with nasal packing

Fire induced changes in soil characteristics in Keşan, Turkey

This research was conducted in Ke an (Çınarlıdere) area (1689 ha) of Thrace region, Turkey. The forest area was burned naturally in 2000. The aim of this research was to determine the effects of forest fire on some soil characteristics two year after the fire. Soil samples were collected from three locations as replicates from both burned and nearby unburnt sites. According to the study results, urease activity and soil organic carbon values (P<0.001), organic nitrogen and total porosity (P<0.01), aggregate stability, microbial biomass carbon values (P<0.05) were lower in burned soils than those of unburned soils. On the other hand, hydraulic conductivity and available phosphorus in unburned soil was not significantly higher than that of burned soils. This research showed negative effects of fire on some soil characteristics after two years

Recurrent Intestinal Intussuseption in Adult: A Case Report

Intussusseption is an usually incident that may present in pediatric patients but we encounter rarely in adults. It leads to obstruction of the gastrointestinal tract. In pediatric patients, etiological factors are due to benign incidents usually, but in adults, often depends on tumors. Etiological factors should be investigated after obtaining the reduction of intussusception and intraluminal pathologies should be excluded. It will cause to intussusseption recurrence after years if reduction perform without treating etiological factors

Bone Cement Ossiculoplasty: Our Long-Term Results

Objective:Assessment of our long-term hearing results in a patient, in whom ossicle chain reconstruction was established by using bone cement and conductive hearing loss was detected, was aimed.Methods:Files and surgery notes of twenty three patients admitted to the Otorhinolaryngology Head and Neck Surgery Clinic of Şişli Etfal Training and Research Hospital due to conductive hearing loss between January 2006 and January 2010, and in whom ossicle chain reconstruction with tympanoplasty and/ or mastoidectomy was performed, were investigated retrospectively. Those admittes at the eighteenth months and later were included in the study. The patients being included into the study were studied in terms of age, gender parameters, examination findings and audiological examinations in the preoperative period, surgery notes and examination findings in the post-operative period, and audiological examinations performed after the eighteenth month.Results:In 21 (100%) of the 21 patients, graft membrane was intact. It was observed that ABG values fell below 20 dB in seventeen patients (80.9%), below 15 dB in thirteen (61.9%) patients and below 10 dB in ten (47.6%) patients. In eighteen (85.7%) patients, improvement of more than 10 dB was ensured compared to pre-operative ABG.Conclusion:Since favorable results of bone cement used for the purpose of ossicular reconstruction were detected, this cheap and easily applicable material can be used safety in ossiculoplasties

Acute Abdomen Caused by Spontaneous Perforation of Hydatid Liver Cyst

Objectives: The aim of this study was to evaluate acute abdomen cases that developed as a result of spontaneous perforations of hydatid liver cysts in our regions, where hydatid cyst disease is endemic. Methods: The records of 218 hydatid cyst patients who underwent surgery at our clinic between 01.01.2012 and 01.08.2016 were retrospectively reviewed. Twelve (5.5%) cases who required emergency surgery due to the rupture of hydatid cysts were included in this study. The cases were reviewed with respect to age, sex, current symptoms, radiological findings, laboratory results and post-operative results. Results: Ten (83.3%) of the 12 patients were females, and two (16.7%) were males, and their me an age was 40.4 y (23–69). All patients with spontaneous perforations had hydatid liver cysts. Eleven of the patients had a single cyst, and one had multiple cysts. Nine patients were diagnosed with ultrasonography (US), and three patients were diagnosed with computed tomography (CT). Conclusions: Hydatid cystic rupture should be considered in cases of an acute abdomen in regions where hydatid cystic disease is endemic. We believe that patients with a single cyst that is peripherally located in the liver ha ve a high risk of spontaneous perforation. Patients who are diagnosed with hydatid cystic rupture should undergo emergency surgery, followed by medical treatment