Using saline bags instead of commercial retrieval bags to reduce the cost of splenic retrieval after laparoscopic splenectomy

BACKGROUND

Laparoscopic splenectomy (LS) is considered the gold standard treatment in adults with idiopathic thrombocytopenic purpura (ITP) refractory to medical therapy. However, the retrieval of the spleen in LS is still a technical challenge, despite the use of various commercial retrieval bags. This study reports the feasibility and reliability of using a saline bag for spleen retrieval in a reduced port splenectomy.

METHODS

Between 2007 and 2020, 55 consecutive patients underwent LS for ITP. Data were collected retrospectively. To retrieve the spleen, a 1 liter sterile saline bag was used.

RESULTS

Fifty-five patients underwent LS. There was only one complication related to the saline bag: an iatrogenic ileal injury during the morselization process.

CONCLUSION

One-liter saline bag is feasible, and widely available. No additional instruments or cost is required and there is no need to extend the wound for spleen retrieval during LS.

KEY WORDS

Idiopathic thrombocytopenic purpura, Laparoscopic surgery, Splenectomy, Techniques.

Comparison of Antithrombin III and Pentoxifylline Treatments in Gram Negative Sepsis Patients Developing Disseminated Intravascular Coagulation

Objective:

The aim of this study was to evaluate the effects of antithrombin III (AT III) and pentoxifylline treatments on the gram negative septic patients with disseminated intravascular coagulation (DIC).

Method:

For six days after plasma AT III activity dropped lower than 80% in Gram-patients who developed DIC were treated with AT III (90-120 IU/kg/day in 6 hours) or pentoxifylline (1.5 mg/kg/h in 6 hours) Fibrinogen, FDP, D-dimer, complete blood count, AT III activity, and DIC scores were calculated and recorded.

Results:

The coagulation tests, AT III activity and FDP started to improve from the second day of treatment with both treatments (p<0.05). D-Dimer started to decrease on the second day of treatment with pentoxifylline (p<0.001) and fourth day of AT III treatment (p<0.05). Fibrinogen levels decreased on the second day of pentoxifylline treatment (p<0.05) and on the last day of AT III treatment (p<0.001). DIC scores started to decrease on the last day of treatment with AT III treatment (p<0.001) and on the third day of treatment with pentoxifylline (p<0.05).

Conclusion:

Both ATIII and pentoxifylline treatments had positive effects on fibrinogen, FDP, D-Dimer, AT III activity and DIC scores in patients with Gram-negative sepsis who developed DIC.

Impact of the mandatory age-based single-embryo transfer legislation in Turkey on outcome of in vitro fertilization: a multicentre study

This study in Turkey evaluated the impact of age-based mandatory single-embryo transfer (SET) legislation with the subsequent increase in frozen-thawed embryo transfer (FT-EU) on pregnancy outcome of in vitro fertilization (IVF) patients. SET, FT-FT and double-embryo transfer were used in 5632 patients after legislation, while traditional IVF and FT-FT approach was used in 6029 patients before legislation. The cumulative pregnancy rate after legislation was slightly lower (38.2%) than before legislation (42.0%) but not significantly so. The single pregnancy rate for SET and traditional IVF were similar between the 2 groups (37.8% versus 28.7%), while multiple pregnancy rates were significantly higher before than after legislation (13.7% versus 0.3%). For FT-ET, the number of cycles was significantly higher after legislation (862 versus 616). SET yielded similar results to traditional IVF. In order to reduce multiple pregnancies without significantly decreasing pregnancy rates, SET might be a successful strategy.

Soy protein diet significantly improves endothelial function and lipid parameters

BACKGROUND

Replacement of animal protein with soy protein in the diet is associated with decreased cholesterol levels. However, the effects of soy protein diet on endothelial function are not well known.

HYPOTHESIS

The aim of the study was to investigate the effects of soy protein diet on plasma lipids and endothelial function parameters assessed by two different methods.

METHODS

Twenty hypercholesterolemic, nonsmoker male patients (age 50.1+/-11.8 years), with a normal body mass index, were included. After calculating their daily requirements, a diet with 25-30% of energy from fats. 10-12% from proteins, and the rest from carbohydrates was instituted. Sixty percent of the animal source proteins of the diet were substituted by soy. The anthropometric measures, lipid parameters, and endothelial functions of the subjects were assessed at baseline and 6 weeks after soy protein diet. Flow-mediated endothelium-dependent dilatation (EDD) and plasma thrombomodulin (TM) levels were evaluated as endothelial function parameters.

RESULTS

After diet, plasma total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels decreased significantly (p <0.001, p < 0.001, p = 0.039, and p = 0.001, respectively). The mean plasma TM levels were also significantly reduced with diet (p = 0.004). Studies of the brachial artery indicated a borderline dilatation in baseline brachial artery diameter (p = 0.05), however the diameter at reactive hyperemia was significantly larger after diet (p<0.001), resulting in a significant improvement of EDD (p = 0.002).

CONCLUSION

Soy protein diet significantly improves plasma lipid profile in patients with hypercholesterolemia. Furthermore, the endothelial function, as judged by two different methods (EDD and plasma TM levels), also improves with soy protein diet.

Does maternal knowledge impact blood phenylalanine concentration in Turkish children with phenylketonuria?

The aim of this study was to compare the level of maternal knowledge and the blood phenylalanine (Phe) control in phenylketonuria (PKU; OMIM 261600). The study was conducted on 144 children (81 boys, 63 girls) with PKU, aged between 1 and 15 years, at Hacettepe University Ihsan Dogramaci Children's Hospital, Metabolism and Nutrition Unit. All subjects were treated with a low-Phe diet using a Phe-exchange system. A 20-question multiple-choice questionnaire was applied to the mothers to determine their knowledge about PKU and its dietary treatment. Questions in the test consisted of the knowledge about the disease (6 questions), general dietary knowledge (14 questions) and knowledge about specific exchange within the dietary questions (6 questions). The median blood Phe concentration for the previous 3-year period was used as an indicator of metabolic control. Eighty-seven children had a median blood Phe concentration above the MRC Working Party Guidelines. There was a negative correlation between maternal knowledge about exchange and median blood Phe concentration in the child (p<0.05). Maternal knowledge about a standard 15 mg Phe exchange system is correlated with dietary compliance as measured by blood Phe concentrations in our subjects. We would like to implement an easier method of measuring Phe exchanges to improve dietary knowledge in the mothers.

Endolaparoscopic approach in the management of gastroesophageal reflux disease: an experimental study in pigs

INTRODUCTION

Chronic reflux of gastric content to the esophagus causes retrosternal burning, pain, and regurgitation, and results in histopathologic changes that may culminate in adenocarcinoma. Insufficiency of the lower esophageal sphincter and hiatal hernia are the two principal causative factors. In this paper, we present the early results of a new antireflux operation in pigs.

MATERIALS AND METHODS

The status of physiologic reflux was determined in 5 pigs (approximately 40-45 kg) with 24-hour pH monitorization. Under endoscopic guidance, a trocar was inserted into the stomach (similar to the percutaneous endoscopic gastrostomy technique). The endoscope was put into the retroflexed position; a mucomuscular pursestring suture was placed around the endoscope at the cardia and tied. Ten days later, pH monitorization was repeated to evaluate the effectiveness of the method. Late postoperative results have been reevaluated by 24-hour pH monitorization in the sixth month.

RESULTS

The procedure achieved statistically significant improvements in total reflux time, number of reflux periods, number of long reflux periods, the longest reflux period, and the DeMeester score. The preoperative and postoperative DeMeester scores of the individual animals were 179.24-0.94, 11.48-0.98, 68.4-3.74, 132.2-46.49, and 38.72-5.86, respectively. Even though there appeared to be a slight increase in the pH monitorization levels after 6 months, these results did not reach significant degrees, and compared to the physiological reflux, the results were remarkable.

CONCLUSIONS

The results obtained showed considerable decreases in physiologic reflux in all animals. We believe that this endoluminal, laparoendoscopic operation can be used in the treatment of gastroesophageal reflux disease as a minimally invasive method.