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Salman A.E.,Etlik Research and Training Hospital | Salman A.E.,Etlik Research and Training Hospital | Yetisir F.,Etlik Research and Training Hospital | Aksoy M.,Ataturk Research and Training Hospital | And 3 more authors.
Hernia | Year: 2014

Aim: Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy®, KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen. Methods: Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged. Results: The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients. Conclusion: Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully. © 2012 Springer-Verlag France. Source

Salman A.E.,Ataturk Research and Training Hospital | Yetisir F.,Ataturk Research and Training Hospital | Kilic M.,Yildirim Beyazit University | Onal O.,Etlik Research and Training Hospital | And 6 more authors.
Journal of Anesthesia | Year: 2014

Purpose: Both parenteral and enteral glutamine have shown beneficial effects in sepsis and ischemia/reperfusion-induced acute lung injury (ALI). Oleic acid (OA) has been used to induce ALI in experimental studies. In this study, we investigated the effects of pretreatment of a bolus dose of enteral glutamine on ALI induced by OA in rats. Methods: Twenty-eight adult female Sprague-Dawley rats weighing 240-300 g were divided into four groups, 7 in each. Group I and group II received normal saline for 30 days, group III and group IV received glutamine at a dose of 1 g/kg for 10 days by gavage, and in group II and group IV 100 mg/kg OA was administered i.v. Histopathological examination of the lung was performed with light and electron microscopy. Levels of protein carbonyl, malondialdehyde, superoxide dismutase, catalase, and glutathione peroxidase levels were measured in tissue samples. Levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and total tissue oxidant status and total tissue antioxidant status were measured in serum samples. Results: Light microscopy showed that the total lung injury score of group IV was significantly lower than group II. Change in thickness of the fused basal lamina was not significantly different in groups II and IV under electron microscopy. TNF-α, IL-6, and IL-10 serum levels were higher in group II when compared to group I and significantly attenuated in group IV. Conclusion: Pretreatment with a bolus dose of enteral glutamine minimized the extent of ALI induced by OA in rats. © 2013 Japanese Society of Anesthesiologists. Source

Salman E.A.,Etlik Research and Training Hospital | Onal O.,Etlik Research and Training Hospital | Yurekli B.,Bozyaka Research and Training Hospital | Simsek E.,Etlik Research and Training Hospital | And 2 more authors.
Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi | Year: 2012

A 74 year old patient, weighing 94 kg, with abdominal distention was admitted to hospital. Her upper and lower abdominal tomography was normal and ultrasonography could not be evaluated optimally because of massive ascites. She had undergone tumor debulking surgery (total abdominal hysterectomy, bilateral salphingo-oophorectomy, total omentectomy, appendectomy, pelvic and paraaortic lymph node dissection) under general anesthesia with prophylaxis for deep vein thrombosis. Pathologic examination revealed tubal carcinoma. At the end of the five hour long operation, the patient was admitted to the ICU for postoperative care. Within hours, progressive coldness and cyanosis bilaterally in the lower extremities were noted in her physical examination. Pulses distal to the femoral arteries were not palpable. Motor and sensory deficits were also present in both of the lower legs in her neurological examination. In her angiography, the aorta was atherosclerotic and a large thrombus, occluding the abdominal aorta, 3 cm distal to renal arteries, was revealed. The patient was taken for emergency embolectomy and treatment for hyperkalemia was also begun. After embolectomy, emergency hemodialysis was planned. However, the patient arrested in ICU and did not respond to cardiopulmonary resuscitation. Aortic thrombosis is a very rare and fatal complication after gyneco-oncologic surgery. Preoperative evaluation and assessment of risk factors should be done carefully and without losing time, since treatment options are very limited in such patients. Source

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