SİLS Port Kullanılarak Yapılan Transanal Minimal İnvaziv Cerrahi (TAMIS): Tek Merkez Kısa Dönem Sonuçları

Aim: Conventional transanal excision was described decades ago for treatment of benign rectal neoplasms. However, the chalanges of this technique leads to use alternative approachs. We evaluated the results of transanal minimally invasive surgery (TAMIS) with single incision laparoscopic surgery (SILS) port in treatment of benign rectal neoplasms. Method: Data of the patients who underwent TAMIS with SILS port in one center were retrospectively analyzed. SILS port was placed through in the anal canal and ultrasonic sealing device was used for excision the tumors. Complications during or after surgery were reported. Patients were followed-up by rectal examination with rectoscopy and recurrences were evaluated. Results: Between July 2015 and March 2020, 20 patients underwent TAMIS at one center. The median age of the patients was 67 (37-79). The procedure was performed in all of the patients with a lithotomy position. Full-thickness defect after complete resection of the lesion was observed in 5 (25%) patients. However, abdominal cavity was not exposed through the TAMIS procedure in any of the patients. The rectal wall defect was not repaired in any of the patients. No major complication occured in the patients. The hospital stay was 1 (1-4) days. The surgical margin was negative in 19 patients (95%). After the follow-up period of 9 (1-43) months, 3 (17%) patients had a recurrence and further surgery was performed. Conclusion: TAMIS using SILS port for the management of rectal neoplasms is a safe and effective for treatment benign rectal lesions.Amaç: Benign rektal neoplazmların tedavisi için geleneksel transanal eksizyon on yıllar önce tanımlanmıştır. Bununla birlikte, bu tekniğin zorlukları, alternatif yaklaşımların kullanılmasına yol açar. Bu çalışmada benign rektal neoplazmların tedavisinde tek insizyon laparoskopik cerrahi (SILS) portu ile transanal minimal invaziv cerrahi (TAMIS) sonuçlarını değerlendirdik. Yöntem: Merkezimizde SILS portu ile TAMIS uygulanan benign rektal neoplazmalı hastaların verileri retrospektif olarak incelendi. SILS portu anal kanal içerisine yerleştirildi ve tümörlerin eksizyonu için ultrasonik mühürleme cihazı kullanıldı. Ameliyat sırasında veya sonrasında komplikasyonlar rapor edildi. Hastalar proktoskopi ve rektal muayene ile takip edilerek nüksler değerlendirildi. Bulgular: Temmuz 2015 ile Mart 2020 arasında 20 hastaya TAMIS uygulandı. Hastaların ortanca yaşı 67 (37-79) idi. Tüm hastalarda litotomi posizyonunda ameliyat edildi. 5 (%25) hastada lezyonun tam olarak çıkarılmasından sonra tam kat defekt görüldü. Ancak hiçbir hastada abdominal boşluğa girilmedi. Hiçbir hastada rektal duvar defekti onarılmadı. Hastalarda majör komplikasyon izlenmedi. Hastanede kalış süresi 1 (1-4) gündü. 19 hastada (%95) cerrahi sınır negatifti. 9 (1-43) aylık takip süresinden sonra 3 (%17) hastada nüks görüldü ve ileri cerrahi yapıldı. Sonuç: Rektal neoplazmların yönetimi için SILS portunu kullanılan TAMIS, benign rektal lezyonların tedavisi için güvenli ve etkilidir

Surgery for Hydatid Cysts of the Liver

This report details the perioperative management of 488 patients who underwent surgery for hydatid cysts of the liver. The most common pathology was a single cyst in the right lobe of the liver (53%). The preferred surgical procedures were partial cystectomy with closure of the residual cavity by suturing (31%) and total cystectomy (18%). Comunication with the biliary system was found in 13% of cysts. The presence of multiple cysts and the need for additional procedures contributed to the overall perioperative morbidity ( 42%) and mortality (1%)

Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding

Background/Aims: There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding. Materials and Methods: The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients. Results: In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038). Conclusıon: Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding

The effects of caffeic acid phenethyl ester on inflammatory cytokines after acute spinal cord injury

BACKGROUND: The purpose of this study was to investigate the effects of Caffeic Acid Phenethyl Ester (CAPE) on proinflammatory cytokines, IL-1 beta and TNF-alpha, and explore its healing effect after acute spinal cord injury

The Effect of Biologics in the Treatment of Multisystem Inflammatory Syndrome in Children (Mis-C): A Single-Center Propensity-Score-Matched Study

Multisystem inflammatory syndrome in children (MIS-C) is a serious condition characterized by excessive inflammation that can arise as a complication of SARS-CoV-2 infection in children. While our understanding of COVID-19 and MIS-C has been advancing, there is still uncertainty regarding the optimal treatment for MIS-C. In this study, we aimed to compare the clinical and laboratory outcomes of MIS-C patients treated with IVIG plus corticosteroids (CS) to those treated with IVIG plus CS and an additional biologic drug. We used the propensity score (PS)-matching method to assess the relationships between initial treatment and outcomes. The primary outcome was a left ventricular ejection fraction of less than 55% on day 2 or beyond and/or the requirement of inotrope support on day 2 or beyond. We included 79 MIS-C patients (median age 8.51 years, 33 boys) followed in our center. Among them, 50 children (25 in each group) were allocated to the PS-matched cohort sample. The primary outcome was observed in none of the patients in the IVIG and CS group, while it occurred in eight patients in the IVIG plus CS and biologic group (p = 0.04). MIS-C is a disorder that may progress rapidly and calls for extensive care. For definitive recommendations, further studies, including randomized control trials, are required