OBJECTIVE:We aimed to investigate the effect of 10 mg/kg sildenafil on the structure and function of the liver in a rat model of obstructive jaundice. MATERIAL AND METHODS:Sixty-two male Wistar albino rats were distributed into six different groups. Obstructive jaundice was performed by legating the common bile duct. 10 mg/kg sildenafil citrate in drinking water was delivered orally after the operation before sacrificing them. Rats were sacrificed either after 10 or 28 days according to the study design. The blood and tissue samples from the liver were obtained to perform a biochemical and histopathological analysis to study functional and structural changes in the liver. RESULTS:At the 10th day, there was no difference between the sildenafil-treated and control groups with regard to the aspartate aminotransferase and alanine aminotransferase levels (p=0.423, p=0.661). The alkaline phosphatase total bilirubin levels among the groups were statistically different (p<0.001). At the 28th day, liver function tests except alanine aminotransferase showed significant differences among the groups (p<0.001). Liver function tests did not changed significantly between the 10th and 28th day in sildenafil-treated rats (p>0.05). Significant differences were observed among the groups with regard to cholestasis, fibrosis, inflammation, and necrosis (p<0.001). However, edema increased in the sildenafil-treated group (p<0.001). On the 28th day, the severity of structural changes in the liver after obstructive jaundice, except edema, reduced significantly (p<0.001). The sildenafil-treated groups at different time points didn't show any statistical difference in histopathological changes (p>0.05). CONCLUSION:Oral administration of 10 mg/kg sildenafil citrate dramatically reverses the biochemical and histopathological liver changes induced by obstructive jaundice in rats.

Purpose/Aim of the study: The main purpose of the colonoscopy is screening for colorectal cancers and diagnosis of colorectal disease The cost-effectiveness of colonoscopy directly depend on the adequate bowel preparation. Inadequate colonoscopy is recommended to be re-scheduled within 1 year. Re-scheduling is an economic and patient burden. Thus instead of re-scheduling, another strategy may be attempted. The purpose of this study was to examine the usefulness and effect of the same day repeat colonoscopy after administration of an additional laxative dose. Materials and Methods: Patients with inadequate colonoscopy were enrolled in the study. The patients eligible for the enrollment were instructed to consume an additional laxative and scheduled in afternoon. The demographic data of the patient, the details of the index and repeat procedures were obtained by a questionnaire. Results: A total of 60 patients were enrolled in the study. The rate of adequate colonoscopy was 80%. Cecum intubation rate was 83.3%. There were no complications due to colonoscopy itself and additional laxatives. The polyp detection rate was 26.6%. The withdrawal time was 6.7 ± 1.34 min. Conclusion: The results of the present study showed that same day repeat colonoscopy with additional laxative dose can be a safe and effective method for repeat procedure of an inadequate colonoscopy. The patients tolerated and were satisfied with the same day protocol. Quality indicators of colonoscopy such as adenoma detection rate and cecum intubation rate were achieved. Same day bowel cleansing method may be considered as an alternative way rather than re-scheduling inadequate colonoscopy for a later time.

Objective: This study aimed to determine the effects of beta-Glucan on colitis induced by acetic acid (AA). Methods: A total of 28 Wistar-Albino male rats were divided into four groups. Intrarectal saline were administered in the group 1. AA colitis model was created in the group 2. Intrarectal saline and B-Glucan were administered in the group 3. beta-Glucan was given daily after induction of colitis in the group 4. beta-Glucan was given by daily gavage for 4 days with 50 mg/kg in the treatment groups. Macroscopically and histologically colon damage was assessed. Biochemically, tumor necrosis factor (TNF) alpha, interleukin (IL)-1 beta, IL-6, myeloperoxidase (MPO), malonyldialdehyde (MDA), glutathione (GSH) and superoxid dismutase (SDO) values were measured. Results: There was improvement in the macroscopic and histological damage in the colon, but was not statistically significant (p>0.05). Biochemically, there was an insignificant difference in MPO, IL-6, TNF alpha and MDA levels (respectively p=0.611, p=0.540, p=0.065, and p=0.129, respectively) while a significant decrease in IL-1 beta, SOD and GSH levels (p=0.012, p=0.013, and p<0.001, respectively). Conclusions: beta-Glucan has protective effects in the treatment of ulcerative colitis.

BACKGROUND:The aim of this study was to examine the effect of intraperitoneally administered bevacizumab on colitis induced by acetic acid. METHODS:An experimental model of acetic acid-induced colitis was introduced in rats. After the induction of colitis, bevacizumab was administered intraperitoneally at two different daily doses of low (2.5 mg/kg) or high (5 mg/kg) concentration. Control groups were included for colitis and bevacizumab. After 7 d, the rats were sacrificed, and colonic tissues were harvested for macroscopic and microscopic examination of colonic damage. Tumor necrosis factor alpha, interleukin 1 beta (IL-1β), IL-6, myeloperoxidase, malondialdehyde, glutathione, and superoxidismutase values were measured biochemically. RESULTS:There was no statistically significant macroscopic improvement in damage to the colon tissues (P > 0.05). The severity of inflammation was significantly reduced (0.98 ± 0.22) in the low-dose bevacizumab-treated rat group compared with the control group (P < 0.001). The decrease in the inflammation score in the high-dose bevacizumab-treated rat group was not statistically significant (1.40 ± 0.33). In addition, although there was no significant change in the myeloperoxidase levels biochemically, IL-6 and malondialdehyde levels decreased in the low-dose treatment group (P = 0.014, P = 0.002, respectively). A significant decrease was found at both treatment doses in IL-1β (P < 0.001, P = 0.010), tumor necrosis factor alpha (P < 0.001, P = 0.015), superoxidismutase (P = 0.046, P = 0.011), and glutathione (P = 0.012 and P < 0.001) levels. CONCLUSIONS:Both treatment doses of bevacizumab were observed to have a protective effect in an experimental colitis model, and the dosage of 2.5 mg/kg bevacizumab was found to have a more prominent effect.

BACKGROUND:The present objective was to identify effects of early melatonin application on healing of anastomotic wound and inflammation in an experimental sepsis model.METHODS:A total of 60 Wistar albino rats were divided into 2 groups. Cecal ligation puncture (CLP) and colonic resection anastomosis were performed on both the control group and the melatonin treatment group. Both groups were divided into 3 subgroups consisting of 10 rats each. One subgroup from each group underwent re-laparotomy at the 16th hour, the next on the 3rd day, and the final subgroup on the 7th day. Presently evaluated were effects of melatonin treatment of early sepsis on interleukin-6 (IL-6), interleukin-10 (IL-10), interferon gamma (INF-γ), and C-reactive protein (CRP) levels, as well as burst pressures (BPs), collagen and hydroxyproline (OHP) content of the anastomotic segments, histopathologic healing, immunohistochemical expressions, CD34, and transforming growth factor beta (TGF-ß).RESULTS:IL-6 and INF-γ levels of the treatment group showed a significant decrease at the 16th hour and an increase on the 3rd and 7th postoperative days. IL-10 levels were significantly higher at the 16th hour and significantly lower on the 3rd and 7th postoperative days in the control group (p<0.001 for each). The treatment group also showed significantly higher capillary permeability, fibroblast proliferation, and collagen deposits (p<0.001 for each). CD34 expression was significantly increased in the treatment group on the 7th postoperative day (p=0.005).CONCLUSION:Application of melatonin in early sepsis significantly improved colonic anastomotic healing in a rat model.

Is it safe to fully adopt laparoscopic approach for the treatment of appendicitis?Comparison of laparoscopic and open appendectomy in a university hospital Apandisit Tedavisinde Tamamen Laparoskopik Yaklaşım Tercih Edilebilir mi? Bir Üniversite Hastanesinde Laparoskopik ve Açık ApendektomininAmaç: Akut apandisit en sık ameliyat gerektiren cerrahi patolojilerden birisidir.Bu çalışmada açık ve laparoskopik yöntemle tedavi ettiği-

OBJECTIVE:This study investigated and compared the effects of antibiotic and steroid lavage on survival and cytokine levels in an experimental abdominal sepsis model.BACKGROUND:In abdominal sepsis, abdominal lavage with saline or antibiotic solutions is a well-documented intervention known to have positive impact on survival; however, the effects of steroid lavage in abdominal sepsis have not yet been investigated.MATERIALS AND METHODS:Ninety-six Wistar rats were divided into 4 groups (n = 24). Abdominal sepsis was induced by cecal ligation and puncture. Six hours after laparotomy, the authors performed a relaparatomy followed by cecal resection and an abdominal lavage. Abdominal lavage was performed using saline in group 1, equal volumes of cefazolin sodium in group 2, low-dose methylprednisolone (1 mg/kg) in group 3, and high-dose methylprednisolone (2 mg/kg) in group 4. After division of 2 subgroups from each of the 4 groups, the first of the rats (n = 12) were euthanized 6 hours later for evaluation of cytokines (ie, interleukin [IL] 1β, 2, 4, 10, and tumor necrosis factor alpha [TNF-α]), and the others were followed for 30 days for analysis of mortality rates.RESULTS:The mortality rate of the rats in group 2 was significantly higher than group 4, which had no mortality (P = 0.032). Although insignificant, the lowest mean value of IL-1β, IL-2, and TNF-α were in group 1, and the highest was in group 2. The lowest IL-4 level was in group 3, and the highest level was in group 2 (P = 0.41). Interleukin-10 levels were significantly lower in group 4 and higher in group 2 (P = 0.014).CONCLUSION:The authors state that peritoneal lavage with prednisolone improved survival rates with increasing doses in abdominal sepsis.

Pneumobilia is the detection of gas within the biliary system. It usually develops after bilioenteric anastomosis, percutaneous or endoscopic biliary interventions, infections and abscesses. The treatment is surgical, especially in cases with no prior interventions to the biliary system. The development of pneumobilia is quite rare after blunt trauma. Therefore, both the diagnosis and management are challenging for surgeons. Herein, we present the diagnosis and conservative management of a patient with pneumobilia after blunt trauma.

Meckel's diverticulum is a rare condition with an incidence of 1-3% in general population. It is usually asymptomatic and is incidentally detected during laparotomy/laparoscopy. Enterolith formation within Meckel's diverticulum is even rarer. Herein, we present the diagnosis and management of a 50-year old patient with Meckel's diverticulum enterolith and discuss this rare condition based on the literature.

OBJECTIVE:The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients.SUBJECTS AND METHODS:A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure.RESULTS:The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively).CONCLUSIONS:Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.

Introduction: Aim was to investigate the effect of methylprednisolone and tenoxicam on the protection of damage of the nerve physiomorphology caused by prolene mesh used in hernia repair.Methods: Fifty male Wistar-albino rats weighing 250-350 gr, were randomly divided into 5 groups. Sciatic nerve was dissected in all rats after performing EMG on basal neural transport. In group 1, only sciatic nerve manipulation was performed. Other groups received a monofilament polypropylene cuff around the sciatic nerve. No additional procedure was performed in group 2. In group 3, 2 mg/kg single dose methylprednisolone was injected around the nerve and mesh. In group 4 and 5, 0.5 mg/kg/day methylprednisolone and 1 mg/kg tenoxicam was injected around the nerve and mesh for 4 weeks, respectively. Neural transport was evaluated by electromyography 4 weeks later and compared with pre-procedural values. Then the rats were sacrificed and, sciatic nerves including 1 cm around the mesh were excised. Inflammation and fibrosis were scored histopathologically.Results: While basal latency was similar, postoperative latency was significantly different among groups. Latency was significantly longer in group 2 than the group 1. It was significantly shorter in group 3 when compared to group 2 (p = 0.007). Preoperative and postoperative amplitudes were similar among groups. Denervation was significantly different among groups (p < 0.05). Denervation was higher in group 2 than group 1. It was similar to group 2 in study groups. Inflammation and fibrosis was significantly different among groups (p < 0.05). Inflammation and fibrosis scores were significantly higher in group 2 than group 1. The highest inflammation and fibrosis scores were detected in repetitive drug administrated groups. Although it wasn't statistically significant, inflammation was lower in single dose steroid administrated group than group 2. Similarly, the highest fibrosis scores were detected in repetitive drug administrated groups. Single dose steroid administration didn't increase fibrosis when compared to group 2.Conclusions: Prolene mesh used in hernia repair caused increased inflammation and fibrosis and effected latency and denervation negatively. Single dose methylprednisolone administration decreased nerve damage and inflammation. On the other hand, daily administration of methylprednisolone and tenoxicam for 4 weeks caused increased inflammation and fibrosis and wasn't affective on protection of nerve physiomorphology. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Inflammatory bowel disease is a serious health problem. Although it has been widely investigated, treatment of inflammatory bowel diseases currently remains as a challenging clinical problem. Over production of nitric oxide has been demonstrated to cause tissue damage and inflammation. In this study, the effect of methylene blue (MB), a well-known inhibitor of nitric oxide synthesis, was investigated in acetic acid (AA)-induced colitis model in Sprague-Dawley rats. Eighty male rats randomized into 4 groups (control, control MB, colitis, colitis + MB). AA was applied to groups 3 and 4. MB was added into group 2 and 4. Three days later, animals were sacrificed and 8 cm distal colonic segment resected and the specimens are examined using macroscopical, histological, and biochemical methods. The results of the macroscopic and microscopic examination showed that in group 4 the mucosal damage and inflammation score significantly lower than group 3. Increased intestinal permeability in acetic acid-administered group was significantly reversed by MB application. Myeloperoxidase activity and malondialdehyde levels increased significantly, while superoxide dismutase and catalase activities were suppressed after AA-administration. These biochemical parameters were reversed in MB-treated group. Administration of acetic acid resulted in increased levels of tumor necrosis factor-α, interleukin-1β, interleukin-6, total nitrite/nitrate levels and nitric oxide synthase activity. These biochemical alterations were significantly reversed by MB application also. In conclusion, our results indicate that MB decreases the level of nitric oxide and decreases inflammation in acetic acid-induced colitis.

To reduce the seroma formation following mastectomy and axillary dissection, many different techniques and drugs have been investigated. The aim of this study is to evaluate the effects of oral β-glucan on drain fluid and efficacy of daily drainage and drain removal day in mastectomy patients.

Acil servislerde travmaya sekonder yumusak dokuda yabanci cisimlere sik rastlanilir. Tum yabanci cisimler hasta ile ilk karsilasildigi anda tespit edilemeyebilir. Burada yumusak dokuda bitki sapi tespit ettigimiz olgumuzu sunmak istedik. 17 yasinda erkek hasta ayak tabaninda agri ve sislik sikayeti ile basvurdu. Fizik muayenede apse tanisi konuldu. Oykusunden 1 hafta once ayak tabanina ot battigi ve acil serviste cikarildigi ogrenildi. Drenaj ve eksplorasyon esnasinda ayak tabaninda 2 adet bitki parcasi bulundu. Yabanci cisimler cikarildi. Antibiyotik tedavisi ile birlikte irrigasyon, debridman ve gunluk yara bakimi ile hasta tedavi edildi.

Phyllodes tumors are fibroepithelial lesions and malign forms are rare neoplasms with lower than 1% of all primary breast tumors. Malign forms are usually behaves like sarcomas because they occur in the stroma of the breast. Also proliferation of epithelium occurs and even it is less often, the epithelial component of phyllodes tumors can transform into malignancy too. This epithelial malignancies are usually in the form of infiltrative carcinomas and non-invasive tumors arising in benign phyllodes tumors are much rarer but can be seen. Literature include very few cases about this situation and cases are usually old woman. We report a 19-year old patient who was diagnosed with ductal carcinoma in situ arising in benign phyllodes tumor of the breast.

Bronkogastrik fistul siklikla major abdominal cerrahi sonrasinda gorulmesine ragmen atesli silah yaralanmalari sonrasinda rezidu yabanci cisimler de fistul gelismesine neden olabilir. Burada atesli silah yaralanmasi nedeniyle yapilan ameliyati takiben bronkogastrik fistul gelismis bir hastamizi sunmayi amacladik. Atesli silah yaralanmasi nedeniyle 6 yil once opere edilmis (mide perforasyonu-primer tamir) 37 yasinda bayan hasta oksuruk, solunum sikintisi ve retrosternal yanma sikayetiyle acil servisimize basvurdu. Hastaya peroperatif yapilan ust gastrointestinal endoskopisinde mide fundus posteriorda internal fistul agzi oldugu ve midenin ventilasyonda sistigi gozlendi. Laparotomi yapilan hastada mide ile diyafram arasinda fistul trakti oldugu goruldu. Hastaya fistul traktini icine alacak sekilde sleeve gastrektomi yapildi ve diyaframdaki fistul acikligi suturler ile tamir edildi. Postoperatif komplikasyon gelismeyen hasta 8. gun taburcu edildi. Bronkogastrik fistul gecirilmis major abdominal cerrahiler sonrasi gorulebilen nadir bir komplikasyon olup yuksek mortalitesinden dolayi hizla tedavi edilmelidirler.

Primer  epiploik apandisit nadir gorulen bi durumdur. Burada akut batin bulgulariyla karsimiza cikan 2 adet olguyu sunmak istedik. Heriki hastaya da supheli akut batin bulgularindan dolayi bilgisayarli batin tomografisi cekildi. BT' de kolon segmentlerinin serozal yuzeyindeki apandiks epiploikalarda enfeksiyon saptandi. Hastalara konservatif yaklasimla, analjezik ve antibiyotik tedavisi baslandi. Semptomlarda 1 hafta icerisinde gerileme oldu. Preoperatif BT bulgulari ile konservatif tedavi verilebilir ve gereksiz cerrahinin onune gecilebilir. Bilgisayarli batin tomografisi ile erken radyolojik degerlendirme tanida anahtar role sahip olup heriki hastada da gereksiz cerrahiden kacinilmasina olanak saglamistir.

Report Of Two CasesPrimer epiploik apandisit nadir görülen bi