Long and Short Term Results of Karydakis Flap Technique for Surgical Treatment of Sacrococcygeal Pilonidal Sinus Disease

Amaç Bu çalışmanın amacı kliniğimizde Karydakis flep ile tedavi edilen sakrokoksigeal pilonidal sinüs hastalığının kısa ve uzun dönem sonuçlarını retrospektif olarak sunmaktır. Gereç ve Yöntem Kasım 2008 ile Aralık 2012 tarihleri arasında sakrokoksigeal pilonidal sinüs tanısıyla ameliyat edilen ve cerrahi yöntem olarak Karydakis flep prosedürü uygulanan 186 hasta incelendi. Hastalar yaş, cinsiyet, ameliyat süresi, postoperatif erken dönem komplikasyon ve nüksler açısından değerlendirildi. Bulgular Olguların 147’si (% 79) erkek, 39’u (% 21) kadındı. Hastaların yaş ortalaması 26±13 yıl idi. Ortalama ameliyat süresi 56 (38-76) dakika olarak bulundu. Hastaların takip süresi ortalama 24 (4-48) ay idi. Bu süre içerisinde 4 hastada (% 2,1) nüks saptandı. Ayrıca 6 hastada (% 3) seroma, 3 hastada (% 1,6) yara yeri enfeksiyonu ve 1 hastada (% 0,53) flep iskemisi gelişti. Sonuç Pilonidal sinüs hastalığı için ideal bir tedavi yöntemi henüz netlik kazanmamıştır. Bu konu güncel cerrahide hâla tartışmaya açıktır. Cerrahi ve cerrahi olmayan yöntemler mevcut olup bu çalışmaya göre Karydakis flep tekniği düşük nüks oranı ile sakrokoksigeal pilonidal sinüsün tedavisinde iyi bir cerrahi yöntemdir.Aim The aim of this study was to determine the long and short term results of Karydakis flap technique retrospectively. Material and Methods A retrospective analysis was done in patients who were treated with Karydakis flap techniques between November 2008 and December 2012. Patients are evaluated in terms of age, sex, time of surgery, postoperative early period complication and recurrences. Results One hundred and forty-seven cases (79%) were male and 39 (21%) were female. The mean age was 26 ± 13 years. Mean operation time was 56 (38-76) minutes. Mean followup time was 24 (4-48) months. Four patients (2.1%) had recurrence in this time. The rates of postoperative complications as seroma, wound infection and flap ischemia are respectively 3 % (n=6), 1.6 % (n=3) and 0.53 % (n=1). Conclusion There isn’t any ideal treatment for pilonidal disease yet. This subject has controversies in actual surgery. There are different procedures, surgical and nonsurgical, for this disease. According to this study Karydakis flap technique, with low recurrence rate, is a good surgical procedure for the treatment of sacrococcygeal pilonidal disease

Factors Effecting Morbidity And Mortality in Obstructing Colorectal Cancers

Aim:The aim of this study is sharing the morbidity and mortality rates and risc factors efecting the morbidity and mortality rates of patients underwent emergency operation in our clinic.Materials and Methods:Between January 2008 - July 2012 eighteen patients, 10 men and 8 women, who operated because of obstructive colorectal cancer, were reviewed. Patients were examined fora ge, sex, complication, operation type, morbidity and mortality. The effects of age, sex and tumor location on morbidity and mortality were examined.Results:Mean age of patients was 66 ± 8,6. Ten patients were elder than 70 (% 56,6). Complet obstruction was seen in 16 patients (% 88,8). In one patient perforation was seen wtih obstrucion (% 5,6). Hartmann’s procedure was performed for 12 patients (% 66,7), loop colostomy was performed for two patients (% 11,2), right hemicolectomy was performed for two patients (% 11,2), total colectomy with ileorectal anastomosis was performed for 1 patient (% 5,6), right hemicolectomy with end ileostomy was performed for 1 patient (% 5,6). Morbidity was seen in 5 patients (% 27,8). Mortality was seen in two patients (% 11,2). Both patients with mortality were elder than 70 (p=0.21). There weren’t any significant difference for sex and tumor’s location.Conclusion:Morbidity and mortality rates increases in patients whom underwent emergency surgery for obstructive colorectal cancer. Being elder patient is one of the reasons. And also accompanied complications like perforation searously increase mortality and morbidity

A comparison in an experimental rat model of the effects on adhesion formation of different hemostatic methods used in abdominopelvic surgery

Objectives: To evaluate the effects of different hemostasis methods used in abdominal surgery on the development of abdominal adhesion.  Material and methods: A total of 48 Wistar albino female rats were separated into six groups; Group 1 — Control group, Group 2 — Hemorrhage group, Group 3 — Electrocoautery group, Group 4 — Gel Spon-P®, Group 5 — PAHACEL®, and Group 6 — Ankaferd-Blood Stopper®. Adhesions that developed were scored according to the Knightly classification and the prevalence of adhesions according to the Linsky classification. The total adhesion score was calculated as the total of the severity and prevalence scores.  Results: The lowest total adhesion values were determined in Group 1 (control) and the highest adhesion values were in Group 2 (hemorrhage) group in terms of all parameters. The adhesion values in Group 3, where the rats were administered hemostasis with electrocautery were similar to those of Group 2 (hemorrhage). When the alternative methods were evaluated, the lowest adhesion scores were in Group 6 (Ankaferd-Blood Stopper®).  Conclusions: In cases of minor pelvic or abdominal bleeding, not providing hemostasis or applying hemostasis with electrocautery can increase the development of intra-abdominal adhesions. The use of alternative hemostatic materials instead of electrocautery for hemostasis may reduce the formation of adhesions

Factors Effecting Morbidity And Mortality in Obstructing Colorectal Cancers

Bu çalışmanın amacı obstrüksiyon yapmış kolorektal kanserler nedeniyle kliniğimizde acil şartlarda ameliyat edilen hastalardaki morbidite ve mortalite oranlarını ve bunlara etki eden faktörleri sunmaktır. Materyal ve Metod Ocak 2008 - Temmuz 2012 yılları arasında mekanik bağırsak tıkanıklığına neden olmuş kolorektal kanser nedeniyle ameliyat edilen 10 erkek ve 8 kadın olmak üzere 18 hasta retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, komplikasyon, yapılan ameliyat, morbidite, mortalite açısından incelendi. Yaşın, cinsiyetin ve tümör yerleşiminin morbidite üzerine olan etkileri incelendi. Bulgular Hastaların yaş ortalaması 66 ± 8,6 idi. 70 yaş üzerinde 10 (% 56,6) vardı. Hastaların 16’sında komplet bir obstrüksiyon izlendi (% 88,8). Bir hastada obstrüksiyonla beraber perforasyon mevcuttu (% 5,6). On iki hastaya Hartmann prosedürü (% 66,7) uygulanırken, 2 hastaya loop kolostomi (% 11,2), 2 hastaya sağ hemikolektomi (% 11,2), 1 hastaya total kolektomi ileorektal anastomoz (% 5,6), 1 hastaya sağ hemikolektomi uç ileostomi (% 5,6) uygulandı. Beş hastada morbidite izlendi (% 27,8). İki hastada mortalite izlendi (% 11,2). Morbidite görülen tüm hastalar 70 yaş üzerindeydi (p=0.21). Cinsiyete göre ve tümörün yerleşim yerine göre ise morbidite oranları açısından anlamlı fark yoktu. Sonuç Obstrüktif kolorektal kanser nedeniyle acil operasyona alınan hastalarda mortalite ve morbidite izlenme olasılığı artmaktadır. Bunun nedenlerinden birisi hastaların daha çok ileri yaşlarda olmalarıdır. Ayrıca hastalarda perforasyon gibi eşlik eden bir komplikasyon varlığı mortalite ve morbiditeyi ciddi ölçüde arttırmaktadır.Aim The aim of this study is sharing the morbidity and mortality rates and risc factors efecting the morbidity and mortality rates of patients underwent emergency operation in our clinic. Materials and Methods Between January 2008 - July 2012 eighteen patients, 10 men and 8 women, who operated because of obstructive colorectal cancer, were reviewed. Patients were examined fora ge, sex, complication, operation type, morbidity and mortality. The effects of age, sex and tumor location on morbidity and mortality were examined. Results Mean age of patients was 66 ± 8,6. Ten patients were elder than 70 (% 56,6). Complet obstruction was seen in 16 patients (% 88,8). In one patient perforation was seen wtih obstrucion (% 5,6). Hartmann’s procedure was performed for 12 patients (% 66,7), loop colostomy was performed for two patients (% 11,2), right hemicolectomy was performed for two patients (% 11,2), total colectomy with ileorectal anastomosis was performed for 1 patient (% 5,6), right hemicolectomy with end ileostomy was performed for 1 patient (% 5,6). Morbidity was seen in 5 patients (% 27,8). Mortality was seen in two patients (% 11,2). Both patients with mortality were elder than 70 (p=0.21). There weren’t any significant difference for sex and tumor’s location. Conclusion Morbidity and mortality rates increases in patients whom underwent emergency surgery for obstructive colorectal cancer. Being elder patient is one of the reasons. And also accompanied complications like perforation searously increase mortality and morbidity

An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study

Objectives: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changesin treatment strategies and complications according to year.Material and methods: A retrospective examination was made of 93 patients applied with caesarean hysterectomy witha diagnosis of placenta percreta in 5-year periods of 2005–2009, 2010–2014, and 2015–2019. Demographic characteristicswere recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight.Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit(ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirementfor massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded.Results: The 93 patients comprised 8 cases in the period 2005–2009, 23 in 2010–2014, and 62 in 2015–2019. The numberof previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase wasobserved in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there wasseen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosisof placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterinefundal incision were greatest in the period 2015–2019.Conclusions: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomescan be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimalprenatal preparation

Umbilikal pilonidal sinüs hastalığında farklı tedavi yöntemlerinin karşılaştırılması

Amaç: Bu çalışmada amaç; üç farklı tedavi yönteminin karşılaştırılması ve sistemik antibiyotik verilmesinin gerekliliğinin araştırılmasıdır. Yöntem: Elazığ Eğitim Araştırma Hastanesi genel cerrahi polikliniğinde çalışmanın yazarları tarafından Ocak 2007- Aralık 2011 tarihleri arasında tedavi edilen umbilikal pilonidal sinus olgularının kayıtları retrospektif olarak incelenerek, hastalar uygulanan tedavi yöntemlerine göre 3 gruba ayrılmıştır. Yalnızca lokal debritman, pansuman ve antibiyotikli pomad uygulanan olgular grup I , sistemik antibiyotik ve lokal debritman uygulanan olgular grup II ve yalnız sistemik antibiyotik uygulanan olgular grup III olarak sınıflandırıldılar. Bulgular: Toplam 53 hasta değerlendirmeye alındı. Kadınların oranı 10 % 18,9 idi. Hastaların ortalama yaşı 22,2 olup, kadınların ortalama yaşı 21,5 erkeklerin ortalama yaşı ise 22,4 idi. Grup 1’deki hastalarda hiç nüks görülmedi fakat tedaviye yanıt alınamaması üzerine 1 % 6 hastaya cerrahi uygulandı. Grup 2 deki hastalarda da nüks izlenmedi fakat tedaviye yanıt alınmaması üzerine 2 % 6 kadın hastaya cerrahi tedavi uygulandı. Grup 3 hastalardan ise 4’ünde % 60 nüks görülerek diğer tedavi yöntemlerine geçildiği görüldü. Sonuç: Umbilikal pilonidal sinus tedavisinde komplike olmayan vakalarda yalnızca lokal debritman, pansuman, umbilikal hijyen ve antibiyotikli pomad uygulanarak cerrahi tedaviye gerek kalmadan etkin bir tedavi sağlandığını düşünmekteyiz. Bunun yanında yalnız sistemik antibiyotik verilen ve lokal debritman yapılmayan olgularda tedavi başarı oranı düşüktür bu nedenle tüm umbilikal pilonidal sinus olgularında lokal tedavinin gerekli olduğu kanaatindeyi

The efficacy of fibrin glue to control hemorrhage from the gallbladder bed during laparoscopic cholecystectomy

Amaç: Laparoskopik kolesistektomi sırasında safra kesesi yatağından gelişen ve klasik yöntemlerle durdurulamayan kanamalarda fibrin yapıştırıcı uygulama deneyimimizi sunmak.Gereç ve Yöntemler: Laparoskopik kolesistektomi uygulanan 382 hastadan, safra kesesi yatağında kanama meydana gelen ve konservatif yöntemlerle durdurulamayan ve bu nedenle de fibrin glue kullanılan 14 hasta retrospektif olarak incelendi.Bulgular: Fibrin yapıştırıcı kullanılan hastaların 10'u (%71) kadın, 4'ü (%29) erkekti. Hastaların ortalama yaşı 55,7 idi. 14 hasta da semptomatik safra kesesi taşı nedeniyle ameliyat edildi. On üç hastada (%92) yandaş bir hastalık mevcuttu. Kanamanın kontrol altına alınarak hemostazın sağlanması için harcanan zaman ortalama olarak 23,9 dakika olarak saptandı. Hemoglobin değeri 8 mg/dL altına düşen 2 hastaya kan transfüzyonu yapıldı. Bir hastada fibrin yapıştırıcı kullanılmasına rağmen kanama kontrolü sağlanamadı ve açık cerrahiye geçildi.Sonuç: Laparoskopik kolesistektomi yapılan hastalarda, karaciğerde safra kesesi yatağından meydana gelen kanamalarda fibrin yapıştırıcı uygulanmasının açığa geçme oranlarını düşürdüğü saptanmış olup bu konu ile ilgili daha geniş çalışmalara da ihtiyaç duyulmaktadırObjective: The aim of the study is to report our experience with fibrin glue application in the management of bleeding from the gallbladder bed during laparoscopic cholecystectomy, which could not be controlled by conventional methods.Material and Methods: Three hundred eighty-two patients underwent laparoscopic cholecystectomy. Fourteen patients with bleeding from the gallbladder bed, which could not be controlled by conventional methods, were analyzed retrospectively.Results: Fibrin glue was used in 10 patients, 6 (71%) were female and 4 were (29%) male. The mean age was 55.7 years. Fourteen patients were operated for the presence of symptomatic gallstones. Thirteen patients (%92) had a concomitant pathology. The mean time spent to maintain hemostasis was 23.9 minutes . Blood products were used in two patients with hemoglobin under 8 mg/dL. Hemostasis could not be achieved in a patient despite fibrin glue application, and the operation was converted to open surgery. Conclusion: The application of fibrin glue for bleeding from the gallbladder bed during laparoscopic cholecystectomy can reduce conversion rates, further studies including more patients are require

Syndecan-1 (CD138) expression in acute myeloblastic leukemia cells - An immuno electron microscopic study

Syndecan-1 (CD138), an important transmembrane heparan sulfate proteoglycan is expressed in distinct stages of cell differentiation. Although its expression in acute lymphoblastic leukemia (ALL) cells is well known; its function or presence in acute myeloblastic leukemia (AML) cells is still largely unknown. The expression of syndecan-1 was studied in bone marrow biopsies of three patients with AML using electron microscopic immunocytochemistry. Positive expression of syndecan-1 was found in AML cells. These results suggest that syndecan-1 expression is not only a characteristic phenotypic marker for ALL, but is also expressed in AML cells

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Diagnosis and management of early gastric band slip after laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) used to be a very popular bariatric procedure at a certain time for the treatment of obesity as it has many advantages and is associated with low morbidity and mortality rates. Complications are often late and are rarely seen by general surgeons due to the limited number of patients, and physicians should be aware of the symptoms. We present a case of a 40-year-old female patient who underwent LAGB and was admitted for a huge gastric pouch dilatation on postoperative day 5. She had a history of food consumption on the fourth day after surgery. She was diagnosed with early gastric band slippage (EGBS). The band was repositioned and gastrogastric sutures were placed to prevent reprolapse of the band. The EGBS is an immediate postoperative complication. Diagnosis of EGBS can be made with oral contrast X-ray studies, and surgical intervention is necessary