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Background and Aim: Umbilical hernia frequently accompanies cholelithiasis. It is possible to repair these hernias after completing cholecystectomy. We herein describe a simple modified technique for the repair., Patients and Method: The technique was applied to 10 patients undergone laparoscopic cholecystectomy. After cholecystectomy has been performed, periumbilical trocar incision is extended toward the umbilicus. The hernia sac is sent into the abdominal cavity and one or two simple sutures are put to approximate the fascial edges of the umbilical hernia. A similar approximation is done for trocar hole. A piece of polypropylene mesh covering both defects with an adequate overlap at four edges is fixed in onlay position., Results: No wound complications were recorded. After a median of 23 months (6-40 months) follow-up no recurrence was observed., Conclusion: This simple modified repair may especially be useful in centers where the surgeons can easily perform cholecystectomy laparoscopically, but are not familiar with laparoscopic hernia repair and mesh placement or haven't the equipment and material necessary for a laparoscopic repair.

Objective: The study was designed to compare the early postoperative results of the commonly used two surgical flap procedures in pilonidal disease: Karydakis and Limberg., Method: One hundred patients were randomized into two groups and standard Limberg or Karydakis procedures were performed. All had primary sinus orifices. Infected cases and the ones with secondary orifices over 2 cm distant from primary were excluded. Data were recorded concerning complications, need for analgesia and wound dressing, periods of time off work and off driving. Patients were asked to classify their first defecation manner after the operation and also pain according to a Visual Analogue Scale with range of 1-10., Results: There was a significantly higher wound infection rate in the Karydakis group than in the Limberg group (13/50 and 4/50 respectively). This also resulted in significantly higher values for wound dressings and need for analgesia. The time off work and off driving and also the Visual Analogue Scale scores were not significantly different between the two groups., Conclusion: Both procedures can be safely performed in pilonidal disease with a standard length of stay in hospital and a similar loss of productive power. However, the Karydakis flap seems to have a significant higher infection rate and this probably increases the cost.

Background: The purpose of this study was to demonstrate the diagnostic value of Ohmann and Eskelinen scores, leukocyte count and ultrasonographic (USG) evaluations in acute appendicitis., Methods: This is a retrospective presentation of 186 patients (105 males, 81 females; mean age 29.94+/-12.70; range 6 to 70 years) operated with the diagnosis of acute appendicitis between May 1, 2004 and January 1, 2005. The diagnostic value of Ohmann and Eskelinen scores, leukocyte counts, and USG evaluations and the differences between the sexes were studied., Results: According to the evaluation of Ohmann and Eskelinen scores, there were significant differences in positive and negative appendectomy between the total patient population and female patients (p=0.01), but no significant difference was found for men (p=0.341 and p=0.217, respectively). The leukocyte count increase and USG evaluations also demonstrated significant differences between negative and positive appendectomy in female patients (p=0.001 and p=0.001, respectively). However, no significant differences in the leukocyte count increase and USG evaluations between positive and negative appendectomy were determined in male patients (p=0.480 and p=0.732, respectively)., Conclusion: Ohmann and Eskelinen scores could be useful in definitive diagnosis of appendicitis especially in primary care units. The leukocyte count increase alone or with the help of USG evaluation could be helpful in the diagnosis of appendicitis especially in females during the reproductive period.

Since publication of our article, "An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature." World J Emerg Surg. 2006, 1: 8 we believe that the case mentioned should have been described as a 'peritoneal encapsulation' rather than 'abdominal cocoon' as concluded in the original publication.

Background: The re-use of sterile packaged polypropylene meshes in hernia surgery is not recommended by the manufacturers. However, especially in developing and underdeveloped countries, many surgeons are obliged to re-use the mesh pieces after resterilization because of economic problems. The purpose of this study was to determine the effects of ethylene oxide and autoclave resterilization on the mechanical properties of polypropylene meshes., Methods: Repetitive ethylene oxide gas and autoclave sterilizations were applied to polypropylene meshes (Herniamesh S.r.l., San Mauro, Italy) up to 3 times and the effects on the mechanical properties were examined. Gas resterilizations were applied for 4.5 hours at 55 degrees C, whereas for autoclave resterilizations the specimens were kept at 134 degrees C and 3 atm pressure for 64 minutes. Ethylene oxide gas-sterilized samples were labeled as G(n) and autoclave-sterilized samples were labeled as A(n). Effects of the resterilizations on maximum load (Fmax), elongation at maximum load (deltaL), and energy required for complete failure of the specimen (E) were measured., Results: Fmax in the groups showed no significant differences. DeltaL values of groups A2, A3, and G3 were found to be significantly lower in comparison with the control group, whereas differences between the control group and other groups were not statistically significant. E values of A2 and A3 groups were significantly lower than that in the control group (P < .05), whereas the differences between the control group and other groups were not found to be statistically significant. No significant variations were determined between samples sterilized 1, 2, or 3 times in scanning electron microscopy micrographs, however, small irregularities were observed on autoclaved samples., Conclusions: Single use of polypropylene meshes is always recommended because of biocompatibility and infection risks. However, if re-use of the open packages is needed, ethylene oxide sterilization is preferred over autoclave sterilization. If ethylene oxide sterilization is not available then 1 cycle of resterilization with an autoclave can be used.

Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation with possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.

Objective: The objective of this study was to evaluate the frequency of posttraumatic stress disorder (PTSD) among the participants of the Turkish Red Crescent Disaster Relief Team after the Tsunami in Asia., Methods: The Clinician Administered PTSD Scale-1 (CAPS-1) was administered to 33 of 36 team members one month after their Disaster Relief Team duty. Along with the CAPS-1 interview, demographic features, profession, previous professional experience, previous experience with traumatic events and disasters also were recorded. To be classified as present, a symptom must have a frequency score of "1" and an intensity score of "2" at the CAPS-1 interview. For a diagnosis of PTSD, at least one re-experiencing, three avoidance and numbing, and two increased arousal symptoms should be present., Results: The PTSD was diagnosed in eight of the 33 (24.2%) participants. No significant difference was detected in the distribution of PTSD diagnosis according to gender, age, profession, professional experience, previous disaster experience, and/or previous experience of traumatic events. However, the severity of PTSD symptoms as measured by the CAPS-1 score was significantly higher in women, nurses, and participants with <3 previous disaster duty experiences., Conclusion: Post-traumatic stress disorder is prevalent within disaster teams and healthcare workers, and measures should be taken to prevent PTSD within this group.

Background: The role of free oxygen radicals in inflammatory conditions is well known. Free radicals cause lipid peroxidation of cellular membranes resulting in cell death. The purpose of this study was to investigate the levels of total anti-oxidant status (TAS), as a marker of anti-oxidant defense system and malondialdehyde (MDA), as a marker of oxidative stress, in the plasma of patients with acute appendicitis., Methods: Fifty-one adult patients with a median age of 31 years who underwent operations with a preoperative diagnosis of acute appendicitis were included in this prospective study. Blood samples for C-reactive protein (CRP), MDA and TAS were collected preoperatively. Groups were compared by using the Mann-Whitney U test., Results: There were 27 patients with acute phlagmenous appendicitis and 19 patients with advanced appendicitis (10 gangrenous and 9 perforated appendicitis), while 5 negative explorations were documented. No significant differences in WBC counts and MDA levels between groups were encountered. Plasma CRP was significantly higher in patients with perforated appendicitis, but not in the other groups. In advanced appendicitis group, TAS level was significantly lower than the other groups. On the other hand, plasma TAS level in acute phlagmenous appendicitis group was significantly higher., Conclusion: A decrease in plasma total anti-oxidant capacity might be a predictor of the progression of inflammation to the perforation in acute appendicitis.

Abdominal cocoon is a rare cause of intestinal obstruction. The abdominal cocoon is probably a developmental abnormality, largely asymptomatic, and is found incidentally at laparotomy or autopsy. Pre-operative diagnosis cannot be often made correctly. This rare entity of intestinal obstruction has been described in the whole literature as a thick fibrotic sac covering the small bowel partially or completely. The etiology of abdominal cocoon is unknown and most often it is found in adolescent girls from tropical or subtropical countries. Complete recovery is generally expected after the removal of the membrane surgically. This paper reports a male patient who has had intestinal obstruction symptoms and has per-operatively been diagnosed as abdominal cocoon.