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    Diagnosis and surgical treatment of intrabiliary ruptured hydatid disease of the liver
    (Sa Medical Assoc, 2004) Taçyildiz, I; Aldemir, M; Aban, N; Keles, C
    Background and objectives. The major complication of hydatid disease of the liver is intrabiliary rupture of the cyst. The purpose of this study was to evaluate the outcome of patients with intrabiliary ruptured hydatid disease of the liver. Method. Using a standardised data collection instrument, case records of patients who were operated on for hydatid disease of the liver diagnosed between January 1990 and December 2001 at Dicle University Hospital (DUH) were searched and 192 patients who had been operated for hydatid disease of the liver were detected. Of these, 20 patients (16 females, 4 males) were retrospectively reviewed for intrabiliary ruptured hydatid disease of the liver. Results. Intrabiliary ruptured hydatid disease of the liver was determined in 10.4% (N = 20) of the patients (N = 192) operated for hydatid disease of the liver. The average age of patients was 38.9 +/- 14.05 years (range 20 - 72 years). The duration of the symptoms was 3.4 +/- 2.13 years (range 1 - 8 years). The most frequent symptoms were right upper quadrant/epigastric pain, dyspepsia, jaundice and pruritus. Diagnosis of hydatid cyst was principally made using ultrasonography. Twelve cysts (60%) were located in the right lobe, 5 (25%) in the left lobe, and 3 (15%) in the right and left lobes. The size of the cysts was 12.6 +/- 5.79 cm (range 6 - 20 cm). The average diameter of the common bile duct (CBD) was 20.45 +/- 8.54 mm (range 10 - 40 mm). Dilated CBD in 16 patients (80%) and daughter cysts and debris in the CBD in 10 patients (50%) were found during operation. Partial cystectomy and capitonnage were performed in all patients. In addition, T-tube drainage in 17 patients, omentoplasty plus T-tube drainage in 2 patients and choleclochoduo-denostomy in 1 patient were carried out during operation. An internal opening of the biliary fistula was found and sutured in 12 patients (60%). Wound infections developed in 6 patients (30%), suppuration of the residual cavity in 4 patients, and wound dehiscence in 2 patients. Two patients (10%) died from sepsis-multiple organ failure and hepatic failure. The average period of hospitalisation was 28.75 +/- 19.1 days (range 10 - 103 days). Conclusions. If bile-stained cystic fluid and a dilated CBD is found in patients with hydatid disease of the liver, choledochal exploration should be performed during operation. T-tube drainage may be preferred in the management of intrabiliary ruptured hydatid disease because of low morbidity, the ability to decompress intrabiliary pressure, easier monitoring of the biliary drainage and smaller alteration of the anatomy.
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    Micronized purified flavonoid fraction may prevent formation of intraperitoneal adhesions in rats
    (Elsevier Science Inc, 2005) Yilmaz, HG; Tacyildiz, IH; Keles, C; Gedik, E; Kilinc, N
    Objective: To evaluate the efficacy of an anti-inflammatory and capillary regulator drug, micronized purified flavonoid fraction (MPFF), in the prevention of postoperative formation of adhesions. Design: A double-blind, controlled study evaluated the efficacy of MPFF in reducing postoperative adhesion formation in a rat model. Setting: Animal care facility of an academic research setting. Animal(s): Thirty Sprague-Dawley female rats randomly divided into three groups. Intervention(s): Starting on day of surgery, group 2 rats received oral MPFF (100 mg/kg per day for 7 days). Group 3 rats were intraperitoneally injected with 5 mL of saline (containing 200 mg/kg per day of MPFF for 3 days). Control rats received no medication. A standardized surgical trauma was applied in all animals. Three weeks after surgery, the rats were killed, and the adhesions were scored according to macroscopic and microscopic scales. Main Outcome Measure(s): Postoperative adhesions. Result(s): Both oral and intraperitoneal administration of MPFF reduced the scores of adhesions according to macroscopic and microscopic scales. There was no difference between the routes of administration. Conclusion(s): A statistically significant reduction in postoperative formation of adhesions was observed after oral and intraperitoneal administration of MPFF in our experimental animal model. However, further studies are required to reveal its mechanism of action.
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    Spontaneous liver hematoma and a hepatic rupture in HELLP syndrome
    (Springer-Verlag, 2002) Aldemir, M; Baç, B; Taçyildiz, I; Yagmur, Y; Keles, C
    Subcapsular liver hematomas and ruptures are unusual fatal complications of HELLP (hemolysis. elevated liver enzymes. and low platelets) syndrome (HS). We present two cases of a spontaneous rupture of subcapsular liver hematoma occurring in HS and review the literature on this subjects. One case demonstrated a secondary rupture of a subcapsulary liver hematoma due to HS in one patient and HS associated with preeclampsia in another. The defects were on the media] and lateral sectors of the left lobe in one patient and on the medial sector of the right lobe in the other patient. In case 1 deep mattress sutures and omentoplasty were performed. and in the other case a defective area was closed with an absorbable gelatin sponge with a hemostatic effect. In addition, the liver was compressed by abdominal towels. A high index of suspicion and immediate recognition are keys to proper diagnosis and management of affected patients. The multidisciplinary approach to the management of these patients led to a remark-able decrease in the mortality rates. Less aggressive treatment is preferable to aggressive intervention such as a hepatic resection in such patients with coagulopathy.
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    Spontaneous rupture of malarial spleen
    (Current Science Ltd, 2000) Yagmur, Y; Kara, IH; Aldemir, M; Büyükbayram, H; Tacyildiz, IH; Keles, C
    Malaria has long been among the most common diseases in the southeast Anatolia region of Turkey. In 1992, 18 676 cases were diagnosed in Turkey, and Diyarbakir city had the highest incidence (4168 cases), followed by SanliUrfa city (3578 cases). Malaria was especially common during 1994 and 1995, with 84 345 and 82 094 cases being diagnosed in these years, respectively. Spontaneous rupture of malarial spleen is rare. We saw two cases during 1998, which are reported herein. Both patients were male, and were receiving chloroquine treatment for an acute attack of malaria. One of the patients had developed abdominal pain and palpitations, followed by fainting. The other patient had abdominal pain and fever. Explorative laparotomy revealed an enlarged spleen in both patients. Splenectomy was performed in both patients. We have identified 15 episodes of spontaneous rupture of the spleen in the English language literature published since 1961. Because of increased travel to endemic areas and resistance to antimalarial drugs, malaria is a major medical problem that is becoming increasingly important to surgeons worldwide. Malaria is a particularly important problem in the southeast Anatolia region of Turkey. Prophylactic precautions should be taken by tourists who travel to this region, especially during the summer.