Browsing by Publisher "Turkish Surgical Society"

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    Is tomography severity index a predictor of prognosis and complications for acute pancreatitis?; [Tomografi şiddet i̇ndeksi akut pankreatitte prognozu ve komplikasyonlarin belirlemede yararlimidir?]
    (Turkish Surgical Society, 2003) Tireli M.
    The mainstay of the treatment in acute pancreatitis is the evaluation of severity of the disease. Various methods of clinical, radiological and biochemical as Ranson criteria, Glasgow scale, APACHE II scorring, peritoneal lavage, abdominal computerized tomography etc. have been used to determine the severity score of the disease. However nobody is still in agreement on a common diagnostic tool in acute pancreatitis. In fact, tomography severity index (TSI) is considered to be superior to the others. In this study, tomography severity index, Ranson criteria and Glasgow scale were compared in terms of the efficacy in determining further complications and also the prognosis of ninety patients with acute pancreatitis. While Ranson criteria and Glasgow scale were used in first 48 hours, tomography severity index was used in the first five days of admission. The patients with 3≥ scores for Ranson criteria and Glasgow scale and the ones with 6≥ scores for TSI were accepted as severe pancreatitis. In this study, the sensitivity and specificity of TSI were better than Ranson criteria and Glasgow scale but no differences were found for sensitivity among these three parameters. The specificity of TSI was better than Glasgow scale with statistically significance (p<0.05). However, no statistically difference was found between the specificity of Ranson criteria and TSI. On the other hand, TSI was superior to Ranson criteria and also Glasgow scale in terms of positive predictive value (p<0.05). TSI was also showed better results with statistically significance for demonstration of pancreatic necrosis, indication of necrosectomy and visualization of peripancreatic fluid collection when compared to Ranson criteria and Glasgow scale (p<0.05). Mortality did not seem to be affected statistically by the three parameters (p>0.05). In conclusion, TSI are better than Ranson and Glasgow scoring systems for prediction of the severity of the disease and local pancreatic complications.
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    Results of 21 patients with pancreatic necrosis and/or abscess treated by continous closed lesser sac or site lavage; [Pankreatik nekroz veya abseli 21 hastanin kapali sürekli Bursa omentalis veya loj lavaji yöntemiyle tedavisi]
    (Turkish Surgical Society, 2005) Tireli M.
    Purpose: The aim of this study was to evaluate the results of necrosectomy and continuous closed lavage of the lesser sac or site in the treatment of pancreatic necrosis and/or abscess. Background: Despite in its improvement in diagnosis and treatment, acute necrotizing pancreatitis is still associated with a high incidence of mortality and morbidity. The management of sterile necrosis is still controversial. Criteria for surgical intervention in sterile necrosis and choice of technique in debridement of necrosis (conventional passive drainage, continuous lavage of the lesser sac or open abdomen) are still matters of debate. Materials and Methods: Between February 1991 and August 2003, 21 patients with necrotizing pancreatitis were treated with necrosectomy followed by continuous closed lesser sac or site lavage. Results: Among our patients, 11 had infected necrosis and 6 had sterile necrosis. Additionally, two patients had infected necrosis and abscess, and two had pancreatic abscesses. Eight cases of acute attack were managed at another clinic however, upon development of large necrosis or abscesses, these patients were subsequently transferred to our clinic. 13 patients were treated at our clinic right from the start. Reasons for surgery in 21 patients were as follows: absence of definite diagnosis (4), pancreatic abscesses (4), infected necrosis (4), persistence or advancement of organ complication despite intensive therapy (3), presentation of sepsis signs (3), organized necrosis (2) and symptomatic pseudocyst (1). Six patients (28.6%) were documented with serious organ-system dysfunction. Three patients (14.3%) died and among those who lived nine patients developed serious complications. The hospitalization period for patients who survived averaged between 10-65 days. (Mean: 34.0). Conclusion: Infected pancreatic necrosis and/or abscess can be treated surgically; but management of sterile necrosis is still controversial. Conservative strategies can be applied succesfully to manage most patients with sterile necrosis. Necrosectomy supplemented by postoperative closed continuous lavage of the site not only offers debridement of devitalized tissue, but also prevents development of new necrosis through nonsurgical removal of necrotic tissue and biologically active and bacterial compounds.
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    Effect of selective gut decontamination on peritoneal fibrinolytic activity in rats; [Ratlarda oluşturulan selektif baḡirsak dekontaminasyonunun peritoneal fibrinolitik aktivite üzerine etkisi]
    (Turkish Surgical Society, 2005) Ilkgül Ö.; Erhan Y.; Aydede H.; Var A.; Onur E.
    Purpose: Our goal with this experiment was to determine the influence of selective decontamination of the digestive tract (SDD) on peritoneal fibrinolytic activity in rats. Materials and Methods: Animals were divided into five groups. Group 1 was subjected to SDD-treated peritoneal adhesion. Group 2 was subjected only to perioneal adhesion. Group 3 was SDD-treated, whereas Group 4 was labeled as the control group. Group 5 was subjected to simple laparotomy. The rats in Group 1 and Group 3 were given SOD (tobramycin 20 mg/l and polymyxin E 25 mg/l) by gavage twice daily for 3 days preceding surgical operation. Control groups were fed orally with standard chow. After a 72-hour waiting period following the operation, biopsies of undamaged parietal peritoneum were obtained from the fibrinolytic parameters in order to measure tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1). Results: Average tPA levels were low in both the sdd-treated group and the sdd+adhesion model group, however no statistical significance was elicited. PAI-1 levels were higher in sdd-treated groups than in other groups, but no significantly meaningful difference was obtained. Conclusion: These results suggest that pretreatment with sdd reduces the peritoneal fibrinolytic activity and might also enhance the peritoneal adhesion formation in rats.
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    Musinous cystic neoplasia mimicking hydatid cyst in the liver: Two rare cases
    (Turkish Surgical Society, 2024) Tekin E.; Taşkin T.; Ayhan S.
    Mucinous cystic neoplasm of the liver (MCN-L) is a rare tumor which accounts for less than 5% of all liver cysts. Although they are considered to be "benign cysts" radiologically and clinically because of their slow growth, they are considered as premalignant. We present two radiologically misdiagnosed cases that operated in a short time range, in order to increase awareness for these rare tumors. A 47-year-old female patient who had no active complaints 58 x 40 mm cystic lesion was detected in the liver, which was diagnosed hydatid cyst radiologically. The pathological examination showed multiloculated cysts which was covered by low-grade mucinous epithelium and ovarian-type stroma on the cyst wall. A 50-year-old female patient presented with abdominal distention. The radiographical screening revealed a 204 x 140 mm cystic lesion that completely fills left lobe of liver which interpreted in favor of hydatid cyst. Histopathologically, the inner surface of the cyst was covered with low grade mucinous epithelium. Ovarian-type stroma was detectable only by immunohistochemistry due to significant bleeding and edema on the wall. The diagnosis of both of our cases was low grade MCN-L. Since cysts were not intact at the time of gross examination, we could not make any comment about surgical margins or total excision. MCN-L is a tumor that creates difficulty in presurgical differential diagnosis because of its rarity and lack of specific radiologic features. Although the prognosis is excellent as a result of total excision in the benign group, relapses have also been reported. © 2024 Turkish Surgical Society. All rights reserved.