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    Evaluation of phagocytic function of the spleen after splenic artery ligation in secondary hypersplenism
    (2003) Vatansev C.; Tekin S.; Şahin M.; Serdengeçti M.; Avunduk M.C.
    The aim of this study was to investigate the effects of splenic artery ligation on the phagocytic functions and morphology of the spleen in rabbits in which secondary hypersplenism was induced by splenic vein ligation (SVL). Thirty New Zealand-type rabbits were included in this study. The rabbits were separated into three groups of 10 subjects each. The first group underwent laparotomy, and the second and third groups underwent laparotomy + splenic vein ligation. At the end of the fourth week, the first and second groups underwent laparotomy while the third group underwent laparotomy + splenic artery ligation. At the end of the eighth week, 1 cc of blood was taken from all rabbits to determine hematological parameters. The rabbits were administered with 0.1 mCi/kg of Tc-99m sulfur colloid, and retention rates in the liver and spleen were determined. The spleens of the rabbits were removed and examined histopathologically. Median liver/spleen retention rates were found to be 26.2 count/pixel in the sham group, 29.1 count/pixel in group II and 55 count/pixel in group III. The retention rate in the spleen was significantly lower in group III (p = 0.0001). Leukocyte levels were similar among the groups while erythrocyte and thrombocyte levels were significantly lower in group II than in the other two groups (p = 0,0001). Histopathologically, wide congestion was observed in group II while extended fibrosis and necrosis were observed in the spleens of group III. Although the application of SAL in secondary hypersplenism cases reduces the severity of hypersplenism, it fails to improve the phagocytic function of the spleen.
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    Percutaneous cholecystostomy with locking trocar: how I do it?
    (2003) Vatansev C.; Belviranli M.
    Cholecystectomy and open cholecystostomy are associated with a high mortality rate in critically ill patients. Ultrasound-guided percutaneous cholecystostomy has a high success rate with few complications. The following method of percutaneous cholecystostomy with locking trocar (LT) under direct laparoscopic vision is seen to be an effective, safe, and practical procedure. After the abdomen is prepared from xiphisternum to symphysis pubis, the umbilicus and surrounding skin are infiltrated with 1% combined lignocaine and adrenaline. A 10-mm laparoscopy trocar is inserted via a 10-mm subumbilical incision. After a camera is inserted via the trocar, the abdomen and gallbladder are exposed. The skin of the geometric projection of fundus is infiltrated with the same solution, and a 5-mm LT is introduced via a 5-mm skin incision directed to the fundus of the gallbladder guided by the direct view of a laparoscope. When the LT has penetrated to the gallbladder, the bile and contents of the gallbladder are aspirated immediately to reduce the pressure, and the trocar is locked. The locked trocar is fixed to the abdominal wall under traction until the completion of peritonization to prevent bile leakage. The gallstones can be extracted through the trocar by a laparoscopy forceps. This technique was used for a 75-year-old woman with calculous cholecystitis and cardiopulmonary insufficiency, and her progress at this writing is good.