Ponte Academic JournalAug 2017, Volume 73, Issue 8 THE EFFECT OF PGG-GLUCAN ON THE BLOOD LEVEL OF TRACE ELEMENT IN WOUND HEALINGAuthor(s): Oguzhan Sunamak ,Semra Ozdemir, Ibrahim Tayfun Sahiner, Ilknur Erenler, Baris Bayraktar, Fadil AyanJ. Ponte - Aug 2017 - Volume 73 - Issue 8 doi: 10.21506/j.ponte.2017.8.9 Abstract:Background:\r\nWound healing is a dynamic process and affected by various parameters. Trace elements are important in wound healing. This study aimed to analyze effects of glucans on levels of zinc and copper in blood.\r\nMethods: \r\nThe study was held on 30 patients with inguinal hernia. Two groups were formed. The first group was given beta Glucan orally for 7days till surgery and other group was non-drug-given group. Blood samples were taken 1 week before operation and at the day of surgery. Levels of zinc and copper were measured. The difference between drug given and non-given group was analyzed statistically.\r\nResults: \r\nZinc level in blood was found to be significantly decreased in Glucan (G) group compared to non-drug given (NG) group. Copper level showed no significant difference between these groups.\r\nConclusion: \r\nBeta glucans have improving effect on wound healing and collagen cross-linking, which is trace element dependent. Further researches on this relationship to develop new clinical approaches combining beta glucans and trace element applications may be done.\r\nKey words; Glucan, zinc, copper, wound healing Download full text:Check if you have access through your login credentials or your institution Username Password

Obesity prevalence has increased all over the world and has become an epidemic disease. Studies in the literature show that obese patients who have undergone various surgical operations have an increased risk of morbidity and mortality. There are several studies on morbidity and mortality in parathyroid surgery. However, there is insufficient information concerning the thyroidectomy outcomes of obese patients. The aim of this study is to evaluate the effect of obesity in the postoperative stage and minimize the disadvantages that can be seen in obese patients undergoing total thyroidectomy.

OBJECTIVE:The main aim of this study is to determine the necessity of cholecystectomy in patients with ultrasound diagnosed symptomatic polypoid lesions of the gallbladder.MATERIAL AND METHODS:The data of 82 patients with polypoid lesions of the gallbladder who had cholecystectomy between 2000 and 2012 were analyzed retrospectively with preoperative ultrasound and histopathology results.RESULTS:The mean age was 48.05±11.18 years (range 25-74 years). All patients underwent preoperative ultrasound examination. Eighteen (22%) of the 82 patients were asymptomatic; their polypoid lesions of the gallbladder were detected with ultrasound during a check-up or other reasons. In 45 (55%) of cases pathology reported no polypoid lesions of the gallbladder. Right upper quadrant or epigastric pain was the most common symptom (41.46%) that led to hepatobiliary ultrasound, the other symptom was dyspepsia (36.59%). On preoperative ultrasound evaluation, 22 patients had multiple polyps, and 9 of these 22 patients had at least 3 polyps.CONCLUSION:There is an inaccuracy of ultrasound to detect polypoid lesions of the gallbladder. After diagnosing polypoid lesions of the gallbladder by using standard ultrasound, further pre-operative diagnostic tests are needed to help discriminating benign lesions from malignant ones, which may prevent unnecessary surgery regardless of symptoms.

Today incarcerated inguinal hernia is one of the initial reasons that causes acute abdomen and requires surgery especially in old patients. Surgery after incarceration and strangulation increases the risk of morbidity and mortality. The aim of this study is to determine the factors that can affect the results of emergency femoral hernia repairs. Records of the 20 patients (22.2 %) who are dignosed hith femoral hernia among 90 patients with incarcerated inguinal hernia who presented to Istanbul University, Cerrahpasa Medical Faculty Emergency Department between years 2000-2004, were analyzed retrospectively. Mean age was 68.5 ± 15.87 years (38-86 years) in women and 58.5 ± 21.24 years (37-88 years) in men. 13 patients (65 %) were over the age of 60. Concomitant diseases were COLD (Chronic Obstructive Long Disease) in seven patients (35 %) and congestive heart failure in six (30 %). Moreover, two patients (10 %) had the history of myokardial infarction, four (20 %) had diyabetes and one (5 %) had small bowel tuberculosis. Seven patients (35 %) required small bowel resection and an end-to-end anastomosis was performed. Postoperatively, thre patients (13 %) had wound infection, two (10 %) had hematoma and one (5 %) had scrotal ecchymosis. Thre (15 %) patients were transformed to intensive care unit postoperatively because of cardiac and respiratory problems. All of the patients were discharged from the hospital after recovery. Results of this study showed that factors like advanced age, long lasting hernia symptoms, concomitant diseases had worsening effects suchas intestinal resection, langer of hospital stay. Early diagnosis and elective surgery are important factors in hernia treatment. If surgery is performed late, especially after incarceration and strangulation morbidity and mortality are significantly higher.

As a result of the efficacity of the medical therapy of peptic ulcer the quantity of the patients those receive surgical treatment are getting lower but it is still a problem as a recurring disease for the patient who had surgery because of peptic ulcer. Alkaline reflux gastritis and recurrent peptic ulcer are the main reasons of the long term unsatisfactory results. The insufficient or improper first surgical operation is usually responsible for the recurrent peptic ulcer. In this study, we evaluated, the retrospective data of 46 patients who underwent repeat surgery because of recurrent peptic ulcer after various surgical treatments between 1989- 2003 in Department of General Surgery at Cerrahpasa Medical Faculty. The patients whose symptoms did not regress with medical therapy or developed side effects due to medical therapy, developed recurrent peptic ulcer during conservative treatment or the ulcers with complication were the candidate of the repeat surgical therapy. The surgical technique was determined according to primary surgery. Some complementary operations were performed such as the accomplishment of insufficient vagotomy and the enlargement of few resections. There were no surgical mortality in our series.

Objectives: Lesions occuring in the retrorectal space are rare and are derived from a variety of embryologic origins. Retrorectal cysts are one of the groups of these lesions. In this study, we presented four patients who had developmental retrorectal cysts and we also reviewed the literature. Methods: Patients who underwent surgical intervention for retrorectal cysts were included in this study. Medical records, results of digital and proctoscopic examination, endorectal ultrasonography, computarized tomography, magnetic resonance imaging and histopathological reports were reviewed retrospectively. Results: Four female patients underwent surgical resection of their retrorectal cysts. All of them were complaining of sense of fullness in the rectum, tenesmus, and dyspareunia. The posterior perineal route was used in all four patients. Mean postoperative stay was 7 (6-8) days. Mean follow-up time was 7 (3-13) years. Histopathological examination of resected specimens revealed epidermal cyst. All patients were discharged without any problem and during long term follow up, no recurrence or discomfort was encountered. Conclusion: Various imaging modalities have been used for the diagnosis and surgical treatment planning of retrorectal epidermoid cysts. We recommend complete surgical resection of these benign lesions.

BACKGROUND AND STUDY AIMS:Due to their high morbidity and mortality, anastomotic leakage and disruption are still serious problems in colonic surgery. Bowel clamps applied during anastomosis in order to prevent abdominal contamination with colonic contents, may cause microcirculation and perfusion problems and subsequent ischemia-reperfusion injury. Papaverine, a myorelaxant and vasodilatator, and pentoxiphylline, a hemorrheologic agent are used for microcirculation disorders and vascular endothelial growth factor (VEGF) is a stimulator of angiogenesis. With this experimental study, we aimed to measure trace element [copper (Cu) and zinc (Zn)] levels in ischemia-reperfusion injury due to clamps after left colonic anastomosis in rats and show the effects of papaverine and pentoxiphylline on VEGF that stimulates angiogenesis in anastomotic healing.MATERIALS AND METHODS:50 female Wistar albino rats were randomized in 5 groups (n: 10). Laparotomy in group 1, left colonic transsection and anastomosis in group 2, and clamp application 1 cm proximal and distal to the anastomosis (for about 20 minutes long) during left colonic transsection and anastomosis in groups 3, 4 and 5 were performed. Additionally, after the operations, pentoxiphylline (Group 4) and papaverin (Group 5) were injected intraperitoneally. On the 10th postoperative day, plasma trace element and plasma VEGF levels were measured.RESULTS:In this study, VEGF levels in group 1 were significantly low and this was explained as being exposed to hypoxic damage less than the other groups. In group 3, VEGF levels were significantly higher showing that the hypoxic stimulus continued without any treatment and in Group 4, significantly lower than Group 3 related to the inhibition of pentoxiphylline. Lower VEGF levels in Group 1 were thought to be related to lower VEGF induction due to less hypoxic effect. Zinc, an important trace element of the antioxidant system showed significantly higher levels in Group 4 with pentoxiphylline treatment, and this was thought to be related to the antioxidant characteristics of pentoxiphylline.CONCLUSIONS:During surgical procedures, care should be taken not to cause ischemia to the intestinal tissues, and trace elements that are important in ischemia reperfusion injury should be replaced appropriately. Although the antioxidant effect of pentoxiphylline in ischemia reperfusion injury may be benefical in treatment, its inhibition of VEGF is a disadvantage in wound healing.

BACKGROUND/AIMS:Partial hepatectomy is performed for the treatment of mass lesions in the liver. Lycopene, which is a carotenoid, is present in various physiologic processes. In this study, the effects of lycopene administration in partially hepatectomized rats were evaluated by assessing various oxidant/antioxidant parameters, remnant liver histology and plasma nitric oxide levels. METHODS:Thirty Wistar albino adult male rats were randomly divided into three equal groups as: Sham, Partial Hepatectomy and Lycopene-Administered + Partial Hepatectomy groups. Lycopene (4 mg/kg), which was dissolved in olive oil, was given to the rats per orally (via gavage tube) (0.1 ml) every day for 6 weeks before partial hepatectomy and for one week after partial hepatectomy. Tissue and blood samples were collected one week after partial hepatectomy. RESULTS:Plasma malondialdehyde (p<0.001) and nitric oxide (p<0.05) levels in the lycopene-administered + partial hepatectomy group were significantly higher than in the partial hepatectomy group. Intraerythrocytic glutathione (p<0.001), plasma (p<0.001) and liver tissue Cu-Zn (p<0.05) superoxide dismutase levels of the lycopene-administered + partial hepatectomy group were significantly lower than in the partial hepatectomy group. CONCLUSIONS:Lycopene administration could be harmful by increasing oxidative stress after partial hepatectomy.

PURPOSE Bacterial translocation is a spread of living and non-living bacteria and bacterial end-products, passing over the mucosal barrier distending mesenteric lymph nodes, blood and viscera. DuraSeal(polyglycolic acid glue) has adhesive power and it usually used in brain or spinal surgery. We aimed to show the barrier system effect using experiments, in which intraabdominal infection induced and translocation from diaphragm to thorax is researched. METHODS We used 90 Wistar Albino male rats weighing 200-250 grams in our experiment. Laparotomy was performed to all groups. After laparotomy, intraperitoneal 1 cc physiological saline was given in Group I (control). 1 x 109 cfu/m/kg (colony forming unit/mililiter/kilograms) E. Coli was injected intraperitoneally in Group II. In Group III, DuraSeal (Confluent Surgical, Inc., Waltham, MA) was sprayed on the diaphragm. After waiting for approximately 2 minutes to see the barrier effect, 1 x 109 cfu/ml/kg E Coli was injected intraperitoneally. RESULTS For the samples taken intraperitoneally, 100% breeding was determined in all groups except Group 1. While no positive staining was observed in the thoraxes of the rats in Group I and Group III at the first hour, the positive staining ratio in the Group II was 70%. The positivity ratio of Group II was 80% and the ratio was 50% in Group III at the third and sixth hours. Regarding hemoculture E Coli positivity, there was no proliferation in the hemoculture samples of Group I at all time periods, whereas it was positive in the other groups excluding the first hour. CONCLUSIONS The synthetic hydrogel Duraseal, which was designed to prevent postoperative fibrosis and air leakage, was able to partially block the translocation of the bacteria to the thorax via lymphatic or directly.

Wernicke's syndrome, caused by thiamine deficiency, is most commonly associated with alcoholism but can also occur in patients who are malnourished or have malabsorption of nutrients for other reasons. Since the classic triad of encephalopathy, nystagmus and ataxia occurs simultaneously in only 10-33% of cases, a high index of suspicion is needed in any patient with confusion and memory loss. In this case report, we present a 56-year-old female patient with metastatic colon cancer complicated with enterocutaneous fistula. She developed Wernicke's encephalopathy precipitated by 5-fluorouracil infusion. Replacement with thiamine rapidly reversed her neurologic symptoms and signs.

While the majority of fistulas in ano result from infection of the anal crypts, complex, recurrent, and/or nonhealing fistulas should always raise the suspicion of a chronic underlying condition. In this paper, we present a 30-year-old male patient with a diagnosis of a complex suprasphincteric fistula caused by a surgical thread left behind after an orthopedic hip operation performed sixteen years ago. Partial fistulectomy, extraction of the foreign material, and debridement procedures were performed. Few cases of such complex fistulas in ano due to foreign materials have been described in the literature. After careful history-taking, meticulous physical examination under general anesthesia should be done in order to deal with this rare type of fistula.

The association between periodontal and cardiovascular disease has received considerable attention. Studies have demonstrated a higher incidence of atherosclerotic complications in patients with periodontal disease. Tissue factor (TF) has been known as a key initiator of the coagulation cascade, and the TF pathway is the primary physiological mechanism of initiation of blood coagulation. Recently, it has been shown that the circulating pool of TF in blood is associated with increased blood thrombogenicity in patients with coronary artery disease (CAD). Various tissues and saliva have been known to have TF activity. Consequently, the aim of this study was to investigate plasma TF levels and TF activity of saliva in periodontitis patients with and without diagnosed CAD. Twenty-six patients with a diagnosis of CAD and 26 systemically healthy patients were examined in the dental clinic, and the Community Periodontal Index Treatment Needs (CPITN) scores were recorded. Plasma TF levels were determined using commercially available ELISA kit. Salivary TF activities were determined according to Quick’s one-stage method. Plasma TF levels were significantly increased in patients with CAD when compared with the control group. There was no difference in salivary TF activities between the 2 groups, but there was a strong and negative correlation between salivary TF activities and CPITN indexes in both groups. In order to determine the possible role of TF activity as a salivary marker in CAD and periodontitis and to fully understand the negative correlation between salivary TF activities and CPITN, TF activity of gingival crevicular fluid that may also affect saliva can be evaluated.

Background and aims : Because of their rarity and late diagnosis, gastro-intestinal bezoars can be treated after the occurrence of some complications such as acute intestinal obstruction, strangulation, decubitus ulceration and bleeding. In this study, reasons. for bezoar formation, measures to be taken and treatment modalities were investigated. Patients and methods : The files of the patients who were found to have gastro-intestinal bezoars and who were treated at Istanbul University, Cerrahpasa Medical Faculty General Surgery Department and Emergency Unit between the years 1970 and 2005 were analysed. Results : Thirteen (30%) of the 44 patients in the study were women, 31 (70%) were men : the mean age was 55.5 +/- 19.6 (range 22-96) years. Enzymatic dissolution (3 patients) and endoscopic fragmentation (four patients) were unsuccessful. Laparoscopic gastrotomy (n=2), gastrotomy(n=16), gastric resection (n=3), enterotomy (n=12), segmental intestinal resection (n=3), gastroduodenotomy (n=1), and gastrotomy + enterotomy (n=3) were performed. In two patients, bezoars were fragmented and milked to caecum. There were no major postoperative complications, except abdominal wound infection in 4 pattents and one patient who had a recurrent intestinal bezoar five years after the operation. One of the patients died because of heart failure on the 7th postoperative day. Mean hospital stay was 9.5 +/- 3.6 days. Conclusion : Even though rarely seen in digestive tract diseases, the probability of BZ formation should always be remembered. After the removal of BZs by conservative methods or surgery, precautions should be taken against recurrence and possible underlying psychiatric disorders should be treated.

BACKGROUND AND OBJECTIVE:The aim of this study was to evaluate the effects of pneumoperitoneum and patient positioning on respiratory mechanics and blood gases in chronic obstructive pulmonary disease (COPD) patients during laparoscopic Nissen fundoplication.METHODS:After the approval of the Ethical Committee, 32 patients were divided into 2 groups as COPD patients (n=16) and normal patients (n=16). Dynamic respiratory compliance (Cdyn), airway resistance, and peak inspiratory pressure were monitored. Measurements were made in 5 time points: after intubation (intubation), Trendelenburg position (Trendelenburg), during laparoscopic Nissen fundoplication surgery after pneumoperitoneum with the Fowler position (Fowler), right before the desufflation with Fowler position (Fowler-end), and after the desufflation in supine position (supine). Samples of arterial blood gases were collected at the same periods.RESULTS:At all periods, there was a significant decrease in Cdyn and arterial oxygen pressure in 2 groups. Although pneumoperitoneum did not exist during Trendelenburg position, the Cdyn (38+/-13 mL cm H2O(-1)) found to be significantly decreased in COPD patients. In 2 groups, the lowest Cdyn value detected during the Fowler-end period was 43+/-8 mL cm H2O(-1) in control group and 34+/-11 mL cm H2O(-1) in COPD group. Whereas the pH decreased at Fowler, Fowler-end, and supine period, arterial carbon dioxide pressure increased (P<0.05). There was no difference for the other parameters.CONCLUSIONS:In COPD patients, Trendelenburg position has negative effect on respiratory mechanics. Pneumoperitoneum and other positions have similar effect on respiratory mechanics in COPD and control patients.

Although successful short-term results have been achieved with the use of overlapping sphincteroplasty and primary end-to- end repairs to treat fecal incontinence due to sphincteric injury, long-term failure rates may reach as high as 50%. This disadvantage associated with tension repairs may be overcome by utilizing a tension-free technique. Here the authors describe a new tension-free technique involving the use of prolene mesh.

Background. The aim of this paper is to assess the effects of halofuginone, a specific inhibitor of synthesis of collagen Type 1, on fibrogenetic process in an experimental model of early pancreatic fibrosis.Methods. Thirty rats were divided into three equal groups: group 1, sham laparotomy; group 2, severe hyperstimulation and obstruction pancreatitis (SHOP) with no treatment; group 3, SHOP with halofuginone treatment group. SHOP model was induced by complete pancreatic duct obstruction and daily cerulein hyperstimulation (50 mu g/kg, intraperitoneally). Halofuginone was administered daily from the operative day (5 mg/kg, intraperitoneally). All of the animals were sacrificed, and blood and pancreatic tissue samples were obtained for biochemical and histopathological. examination on the 5th postoperative day.Results. No mortality was observed in any group. Serum amylase, lipase, hyaluronic acid, and nitric oxide levels were significantly higher in groups 2 and 3 compared with group 1 (P < 0.05), but were significantly lower in group 3 compared with group 2 (P < 0.05). No significant differences were observed regarding serum malondialdehyde and glutathione levels between groups 1 and 3. Tissue hydroxyproline levels were found to be significantly higher in groups 2 and 3 compared with group 1 (P < 0.001), but were significantly lower in group 3 compared with group 2 (P < 0.001). Although tissue hydroxyproline levels were significantly higher in the halofuginone treatment group compared with the control group, histopathological evaluation did not reveal a significant difference between these groups regarding collagen deposition. When group 3 was compared with group 2, halofuginone significantly reduced inflammation and acinar atrophy in the pancreas as well (P < 0.05).Conclusion. Halofuginone was found to be effective in reducing SHOP-related inflammation, acinar atrophy, and fibrosis in the pancreas. (C) 2008 Elsevier Inc. All rights reserved.

Mesenteric cysts are rare intraabdominal benign cystic lesions. These lesions are most commonly located in the ileal mesentery, without any sex predilection. Mesenteric cysts may be totally asymptomatic and discovered incidentally during routine radiologic examinations. Chronic abdominal pain or acute abdomen may be accompanying to these lesions. Ultrasonography, computed tomography and magnetic resonance imaging are valuable in the diagnosis. Rarely, these lesions may be presented with rupture after trauma. We present a patient with a ruptured ileal mesenteric cyst due to a blunt abdominal trauma and diagnosed by emergency laparotomy.