Inorganic Foreign Body in Rectum: Case Report

Bu yazıda başkaları tarafından zorla makatına yabancı cisim sokulduğunu iddia eden ancak çelişkili ifadelerde bulunan ve genital bölgede herhangi bir lezyon gözlenmeyen 39 yaşındaki erkek hasta sunulmuştur. Şahsın muayenesinde; batında hiperaktif barsak sesleri ve sol alt kadranda hassasiyet saptanmıştır. Anal muayenesinde saat 07:00 hizasında 0,4 x 0,1 cm boyutunda yüzeyel fissür görülmüştür. Pililerin ödemli ve hiperemik olduğu görülmüş, rektal tuşede ampulla boş ve sfinkter tonusu normal değerlendirilmiştir. Genel anestezi altında anoskopla yapılan muayenesinde rektumun yaklaşık 10 cm proksimalinde metal vasıfta yabancı cisim saptanmıştır. Sol alt kadrandan yapılan elle kompresyonla cisim anüsten doğurtularak operasyona son verilmiştir. Rektal yabancı cisim bulunan olgumuzda genital bölgede ve diğer vücut bölgelerinde travmatik lezyonun bulunmaması ve ifadelerin çelişkili bulunması olayın etiyolojisi açısından psikopatolojik bir hastalığın bulunabileceğini düşündürmektedir.In this report we present a 39 years old patient who claims to be sexually assaulted by anal foreign body insertion. His statements were contradictious and he has no lesions on anal region. Abdominal examination of the patient revealed hyperactive bowel sounds and tenderness on left lower quadrant. Only a fissure with dimensions of 0,4 x 0,1 cm's at the 7 o'clock position is detected. Anal folds were hyperemic and edematous. In digital examination, tonus was normal and ampulla was empty. Ten cm’s proximal to rectum, a metal foreign body was detected by anascopy. Under general anesthesia, the foreign body was manipulated and taken through the rectum. Psychopathological etiologies should be taken under consideration because of contradictious statements of the patient and absence of any traumatic lesions on genital region and other body parts

Radyoaktif İyot Tedavisi Sonrası Diferansiye Tiroid Kanserlerinin Takibi-The Follow-up of Differentiated Thyroid Cancers After Radioactive Iodine Treatment

Differentiated thyroid cancerc (DTC) which have very good prognosis are the most common endocrine malignancies. Radioactive iodine treatment (RIT) applied to selected patients after thyroidectomy is a highly effective treatment method. Post-treatment follow-up of these patients exhibits a great importance because of the higher relapse rates and development of distant metastases in some cases. In this review, the methods used in the follow-up DTC patients after RIT are reporte

Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy

BACKGROUND: Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.METHODS: This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.RESULTS: A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.CONCLUSION: In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopyBACKGROUND: Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.METHODS: This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.RESULTS: A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal-knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.CONCLUSION: In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscop

Protective Effects of Curcumin on Formaldehyde Induced Hepatotoxicity and Oxidative Stress in Rats

Amaç: Formaldehit, çeşitli endüstri alanlarında kullanılan kimyasal bir maddedir. Ayrıca, tıpta da kullanımı vardır. Endüstride ve tıp laboratuarlarında formaldehite maruz kalınabilmektedir. Çeşitli çalışmalarda kurkuminin, çeşitli maddelerle sıçanlarda oluşturulmuş karaciğer hasarını önleyici etkisi gösterilmiştir. Bu amaçla çalışmamızda sıçanlarda deneysel olarak formaldehite bağlı karaciğer toksisite oluşturulması ve kurkumin verilerek formaldehitin olumsuz etkilerinin önlenmesi planlandı. Gereç ve Yöntem: Çalışmamızda 21 adet sıçan 3 gruba ayrıldı: Kontrol grubu, Formaldehit grubu ve Formaldehit+Kurkumin grubu. 30 günlük formaldehit uygulaması sonunda sıçanlar ketamin-xylazin anestezisi altında sakrifiye edildi ve karaciğer dokusu çıkartılarak histopatolojik ve biyokimyasal değerlendirmeler yapıldı. Işık mikroskobik incelemeler için alınan karaciğer dokusu Bouin solüsyonu içinde fikse edilerek parafin inklüzyonu yapıldıktan sonra, elde edilen bloklardan 5 ?m kalınlığında kesitler alınarak histolojik yapı değişikliklerinin incelenmesi için hematoksilen-eozin (H&E) ile boyandı. Ayrıca biyokimyasal olarak dokuda malondialdehit (MDA), süperoksit dimutaz (SOD), glutatyon peroksidaz (GSH-Px) ve katalaz (KAT), nitrik oksit (NO) ve ksantin oksidaz (XO) düzeylerine bakıldı. Alınan serum örneklerinde ise Tümör nekrozu faktörü (TNF), chitinase-3-benzeri protein 1 (YKL-40), interlökin-6 (IL-6), dönüştürücü büyüme faktörü beta (TGF-?) ve periostin düzeylerine bakıldı. Bulgular: Sadece formaldehit uygulanan grupta oksidatif hasarı gösteren TNF, YKL-40, IL-6, TGF-?, periostin, MDA, NO ve XO düzeylerinde anlamlı bir artış görülürken CAT, SOD ve GSH-Px seviyesinde ise anlamlı bir azalma tespit edildi. Formaldehit ile birlikte kurkumin uygulanan gruplarda ise bu değişimlerin kontrol grubu lehinde düzeldiği gözlemlendi. Formaldehit grubun karaciğer doku kesitlerinde ise hepatositlerde dejenerasyon, sitoplazmik vakuolizasyon, sitoplazmik kayıp ve hipertrofik hepatositlerin varlığı görüldü. Formaldehit ile birlikte kurkumin uygulanan grupta ise, karaciğer doku kesitlerinde meydana gelen histopatolojik değişikliklerin düzeldiği tespit edildi. Sonuç: Antioksidatif ve koruyucu etkileri olan kurkuminin, formaldehit maruziyetinin sıçan karaciğerlerinde neden olduğu histopatolojik değişiklikleri ve oksidatif hasarı önlediği görüldü.Objective: Curcumin (Cur), a polyphenolic antioxidant derived from the turmeric root has undergone extensive preclinical development, showing remarkable efficacy in wound repair, cancer and inflammatory disorders. Formaldehyde (FA) is a colorless toxic chemical. It is used as a disinfectant in medicine, in addition to its use as a fixative in anatomy, pathology, and histology laboratories. The aim of this study was to investigate the protective effect of Cur on FA induced hepatotoxicity and oxidative stress. Material and Method: A total of 21 Sprague dawley male rats were divided into three groups: control, FA and FA treated with Cur. FA and FA + Cur treated groups received i.p injection of 10 mg/kg FA for 30 days. The rats in the Cur-treated group were given Cur (100 mg/kg) once a day intra gastric for 30 days starting with FA administration. Liver tissues and blood samples were collected for histopathological and biochemical analysis. Results: In FA group, a significant increase in MDA, NO and XO levels was observed in liver tissues and a significant decrease in the levels of CAT, SOD and GSH-Px activities in liver tissues was determined when compared with control group. In addition, a significant decrease in MDA, NO and XO levels was observed in curcumin treated rats and a significant increase was determined in the levels of CAT, SOD and GSH-Px activities in liver tissues, when compared with FA group. FA caused significant increases in TNF, YKL-40, IL-6, TGF-?, periostin levels in plasma. In the FA group, degeneration in hepatocytes, cytoplasm vacuolization, cytoplasm losses and hypertrophic hepatocytes were observed. The Cur treated rats in the FA group showed an improved histological appearance and serum TNF, YKL-40, IL-6, TGF-?, periostin levels. Conclusion: It was concluded that Cur treatment might be beneficial in preventing FA-induced hepatotoxicity and oxidative stress in liver tissue damage, therefore, shows potential for clinical use

Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital ?

BACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality.METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality.RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked.CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reducedBACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality.METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality.RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked.CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduce

Inorganic Foreign Body in Rectum: Case Report

In this report we present a 39 years old patient who claims to be sexually assaulted by anal foreign body insertion. His statements were contradictious and he has no lesions on anal region. Abdominal examination of the patient revealed hyperactive bowel sounds and tenderness on left lower quadrant. Only a fissure with dimensions of 0,4 x 0,1 cm's at the 7 o'clock position is detected. Anal folds were hyperemic and edematous. In digital examination, tonus was normal and ampulla was empty. Ten cm’s proximal to rectum, a metal foreign body was detected by anascopy. Under general anesthesia, the foreign body was manipulated and taken through the rectum. Psychopathological etiologies should be taken under consideration because of contradictious statements of the patient and absence of any traumatic lesions on genital region and other body parts

Ateşli Silah Yaralanmasında Gözden Kaçan İncebarsak Yaralanması: Olgu Sunumu

Yüksek kinetik enerjili ateşli silahlarla meydana gelen abdominal yaralanmalarda ilk laparatomide gözden kaçan yaralanmalar özellikle savaş bölgelerinde sık karşılaşılan bir durumdur. En önemli sebebi yetersiz cerrahi eksplorasyon ve cerrahın deneyimsiz olmasıdır. Çok erken tespit edilerek tedavi edilenler dışında mortalite oranı yüksektir. Önlenmesi için yaralıların değerlendirilmesi ve eksplorasyonu sistematik bir şekilde yapılmalıdır. Hemodinamik olarak instabil olan yaralılarda hasar kontrol cerrahisi prensipleri uygulanmalıdır. Bu yazıda yüksek kinetik enerjili ateşli silahla abdominal bölgeden yaralanma sonrası laparotomi yapılan, ancak peritonit gelişmesi üzerine hastanemize gönderilen ve relaparatomide incebarsakta gözden kaçan yaralanma tespit edilen 21 yaşındaki erkek hastayı sunduk.Anahtar kelimeler: Gözden kaçan yaralanma, Ateşli silah yaralanması, Hasar kontrol cerrahis

WOLFF PARKiNSON WHiTE SENDROMLU HASTANIN ANESTEZİ YÖNETİMİ: OLGU SUNUMU

Wolff-Parkinson-White syndrome (WPW) is