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BACKGROUND/AIMS The aim of this study was to investigate the effects of Nigella sativa (NS) oil form on reducing the damage caused by indomethacin in the stomach and duodenum of rats owing to their antioxidant and anti-inflammatory properties. MATERIAL and METHODS The rats were divided into 4 groups: group 1, saline-treated control group; group 2, NS-treated control group; group 3, saline-treated ulcer group and ulcers caused by indomethacin (30 mg/kg) and administration of physiological serum; group 4, NS-treated ulcer group, which is the group receiving NS oil after administration of indomethacin. At the end of the study, blood samples collected from animals were examined for tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and glutathione (GSH), malondialdehyde (MDA) levels and myeloperoxidase (MPO),and Na+/K+-ATPase activities in gastric and intestinal tissue samples. RESULTS Levels of TNF-alpha and IL-1 beta in serum and MDA and MPO values in tissue were found to be higher in the saline-treated ulcer group than in the saline-treated control group. In addition, tissue GSH and Na+/K+-ATPase levels were found to be lower. These values were found to be reversed when comparing NS-treated ulcer group to saline-treated ulcer group. Histopathological findings showed epithelial regeneration and improvement instead of dense tissue damage. CONCLUSION The strong antioxidant and anti-inflammatory effects of NS against potential small intestine and gastric damage were shown using an experimental indomethacin-induced ulcer model in rats. Hence, our study suggests that NS used together with indomethacin can prevent gastrointestinal damage; thus, this agent can create a new clinical therapeutic principle.

Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.

BACKGROUND The aim of the present study was to investigate morbidity and mortality-related risk factors in patients undergoing surgery due to incarcerated abdominal wall hernia. METHODS The patients were grouped according to the type of hernia (inguinal, umbilical, incisional, femoral), and these groups were evaluated in terms of risk factors affecting morbidity and mortality such as age, gender, American Society of Anesthesiologists (ASA) score, type of anesthesia, concomitant diseases, and the presence of intestinal strangulation and necrosis. RESULTS Inguinal hernia was frequent in males, whereas femoral hernia was frequent in females (p

Objectives This study aimed to investigate the antioxidant and anti-inflammatory effects of caffeic acid phenethyl ester (CAPE) on the methotrexate (MTX)-induced hepatorenal oxidative damage in rats. Methods Following a single dose of methotrexate (20 mg/kg), either vehicle (MTX group) or CAPE (10 µmol/kg, MTX + CAPE group) was administered for five days. In other rats, vehicle (control group) or CAPE was injected for five days, following a single dose of saline injection. After decapitation of the rats, trunk blood was obtained, and the liver and kidney tissues were removed for histological examination and for the measurement of malondialdehyde (MDA) and glutathione (GSH) levels and myeloperoxidase (MPO) and sodium potassium-adenosine triphosphatase (Na+/K+-ATPase) activity. TNF-α and IL-1β levels were measured in the blood. Key findings Methotrexate administration increased the tissue MDA levels, MPO activity and decreased GSH levels and Na+/K+-ATPase activity, while these alterations were reversed in the CAPE-treated MTX group. Elevated TNF-α and IL-1β levels were also reduced with CAPE treatment. Conclusions The results of this study revealed that CAPE, through its anti-inflammatory and antioxidant actions, alleviates methotrexate-induced oxidative damage, which suggests that CAPE may be of therapeutic benefit when used with methotrexate.

Aim Our aim in this study was to evaluate patient outcomes resulting from the follow-up and treatment of pelvic cavity fractures and their common accompanying organ injuries.

INTRODUCTIONAtypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.PRESENTATION OF CASEA 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.DISCUSSIONWhile appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.CONCLUSIONAtypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.

Patient: Female, 45 Final Diagnosis: Neuroendocrine tumor Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Unusual setting of medical care Background: Neuroendocrine tumor of the ampulla of Vater is extremely rare and is generally a low-grade endocrine cell tumor. The merits of radical vs. local resection remain uncertain. Case Report: A 45-year-old female patient presented with abdominal pain lasting for 2 months. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in endoscopic retrograde cholangiopancreatography. Biopsy was histologically confirmed as a low-grade neuroendocrine tumor. No lymphadenopathy or visceral metastasis was found on an abdominal CT scan, In-111 octreotide scan, and EUS. The ampulla was removed by endoscopic snare papillectomy. All margins of resection were negative for tumor. Conclusions: Endoscopic snare papillectomy may be the first step in the management of neuroendocrine tumors of the ampulla of Vater in high-risk surgical candidates and selected patients such as those with a well differentiated, low-grade, small tumor without regional/ distant metastasis. However, it can also be used in younger patients who wish to avoid surgical resection.