No abstract

Morgagni-Larrey hernia is a rare type of diaphragmatic hernia, the diagnosis of which is made incidentally by routine chest X-ray film. We describe a technique for the laparoscopic repair of Morgagni-Larrey hernia which was successfully performed in three adult patients; two women and one man. Two of the patients were asymptomatic and had herniation of only omentum into the right hemithorax; however, one was symptomatic and had herniation of the omentum and large bowel. Tension-free closure of the defects was done using Prolene mesh with a hernia stapler, helical fastener, and Endostitch. There were no early complications and the patients were discharged on the fourth postoperative day. The mean follow-up period was 41 months, and there has been no late morbidity or mortality related to this procedure. Using a laparoscopic approach to repair a Morgagni-Larrey hernia provides an excellent view of the surgical field and allows easy manipulation with minimal surgical trauma, followed by rapid recovery of the patient.

A 71-year-old man was admitted to the emergency unit with upper gastrointestinal bleeding, due to a gastric lipoma, which was controlled with conservative measures. Endoscopy and computed tomography revealed a 4-cm submucosal mass located in the posterior wall of gastric antrum. The patient underwent an elective laparoscopic transgastric resection of the lipoma and discharged on postoperative day 6. Gastric lipomas are uncommon tumors that can be incidentally found. They produce symptoms similar to peptic ulcer disease and can lead to obstruction. Gastric lipomas, which may lead to life-threatening complications such as bleeding, can be safely and reliably treated by laparoscopic transgastric resection.

AMAÇBu çalışmada, sıçanlarda oluşturulan deneysel duodenum perforasyonunda klasik cerrahi teknikler ile adezyon bariyerleri olan DuraSeal ya da fibrin yapıştırıcıyla yapılan dikişsiz onarım tekniklerinin karşılaştırılması amaçlandı. GEREÇ VE YÖNTEMKırk adet yetişkin, ağırlıkları 250-300 g arasında olan, dişi Wistar Albino sıçan rastgele dört adet eşit gruba ayrıldı. Primer onarım grubu, primer onarım ve omentoplasti grubu, fibrin yapıştırıcı uygulanan grup ve DuraSeal uygulanan grup. Doku iyileşmesini değerlendirmek amacıyla patlama basıncı, doku hidroksiprolin seviyesi ve histopatolojik inceleme parametre olarak kullanıldı. BULGULARPrimer onarım, primer onarım ve omentoplasti gruplarının patlama basıncı değerleri fibrin yapıştırıcı ve DuraSeal grubu patlama basıncı değerlerine göre anlamlı olarak yüksek-ti (p<0,001). Biyokimyasal ve histolojik parametreler açı-sından tüm gruplar arasında anlamlı farklılık yoktu. SONUÇDeğerlendirdiğimiz dikişsiz onarım tekniklerinin konvansiyonel onarım tekniklerine üstün etkilerinin olmadığını gözlemledik. Dikişsiz onarım gruplarının sonuçları benzerdi. DuraSeal, fibrin yapıştırıcı gibi dikişsiz onarım alanın-da alternatif olabilir. Bu çıkarım farklı yara iyileşmesi belirteçleri ve farklı yöntemlerle planlanmış çalışmalarla desteklenmelidir.Anahtar Sözcükler: DuraSeal; duodenal perforasyon; fibrin yapış-tırıcı; dikişsiz tamir.

Oxydant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxydant defense mechanism. This study is designed to investigate the possible role of oxydant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control(C) (N=7); Renal ischemia (RI) (N=7); Obstructive jaundice+renal ischemia (OJ+RI) (N=7); Obstructive jaundice (OJ) (N=7). All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD), Superoxide Dismutase (SOD) and Catalase in renal cortex and Glutathione Peroxidase (GSH-Px), in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p <0.05). When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 ±0.01 U/g (tissue) and 0.362±0.03 U/g (tissue) respectively] (p <0.05). SOD and GSH-Px activities of each ischemic group at 3rd day were decreased compared to non-ischemic groups. This fall was significant (p <0.05). But there was no statistical difference between jaundiced and non-jaundiced groups. Alterations in catalase activities also had no statistical significance.These findings may suggest that the injury induced by oxygen free radicals at re-oxygenation of tissue after ischemia may also play a role in the pathogenesis of acute renal failure developed in obstructive jaundice.